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NORTH CAROLINA
REGISTER
Volume 18, Issue 5
Pages 344 - 416
September 2, 2003
This issue contains documents officially filed
through August 11, 2003.
Office of Administrative Hearings
Rules Division
424 North Blount Street (27601)
6714 Mail Service Center
Raleigh, NC 27699-6714
(919) 733-2678
FAX (919) 733-3462
Julian Mann III, Director
Camille Winston, Deputy Director
Molly Masich, Director of APA Services
Ruby Creech, Publications Coordinator
Linda Dupree, Editorial Assistant
Dana Sholes, Editorial Assistant
Rhonda Wright, Editorial Assistant
IN THIS ISSUE
I. PROPOSED RULES
Administration
State Building Commission......................................344 - 347
Environment and Natural Resources
Health Services, Commission for............................385 - 388
Health and Human Services
Medical Care Commission........................................347 - 385
Licensing Boards
Nursing, Board of.......................................................394 - 399
Transportation
Highways, Division of...............................................388 - 394
II. TEMPORARY RULES
Administrative Hearings, Office of
Rules Division – Expired Temporary Rules ..........400
III. RULES REVIEW COMMISSION..........................401
IV. CONTESTED CASE DECISIONS
Index to ALJ Decisions.................................................402 - 404
Text of Selected Decisions
02 INS 1257.................................................................405 - 409
02 OSP 1001................................................................410 - 416
For the CUMULATIVE INDEX to the NC Register go to:
http://oahnt.oah.state.nc.us/register/CI.pdf
North Carolina Register is published semi-monthly for $195 per year by the Office of Administrative Hearings, 424 North Blount Street, Raleigh, NC
27601. North Carolina Register (ISSN 15200604) to mail at Periodicals Rates is paid at Raleigh, NC. POSTMASTER: Send Address changes to
the North Carolina Register, 6714 Mail Service Center, Raleigh, NC 27699-6714.
NORTH CAROLINA ADMINISTRATIVE CODE CLASSIFICATION SYSTEM
The North Carolina Administrative Code (NCAC) has four major subdivisions of rules. Two of these, titles and
chapters, are mandatory. The major subdivision of the NCAC is the title. Each major department in the North
Carolina executive branch of government has been assigned a title number. Titles are further broken down into
chapters which shall be numerical in order. The other two, subchapters and sections are optional subdivisions to
be used by agencies when appropriate.
TITLE/MAJOR DIVISIONS OF THE NORTH CAROLINA ADMINISTRATIVE CODE
TITLE DEPARTMENT LICENSING BOARDS CHAPTER
1
2
3
4
5
6
7
8
9
10
11
12
13
14A
15A
16
17
18
19A
20
*21
22
23
24
25
26
27
28
Administration
Agriculture
Auditor
Commerce
Correction
Council of State
Cultural Resources
Elections
Governor
Health and Human Services
Insurance
Justice
Labor
Crime Control & Public Safety
Environment and Natural Resources
Public Education
Revenue
Secretary of State
Transportation
Treasurer
Occupational Licensing Boards
Administrative Procedures (Repealed)
Community Colleges
Independent Agencies
State Personnel
Administrative Hearings
NC State Bar
Juvenile Justice and Delinquency
Prevention
Acupuncture
Architecture
Athletic Trainer Examiners
Auctioneers
Barber Examiners
Certified Public Accountant Examiners
Chiropractic Examiners
Employee Assistance Professionals
General Contractors
Cosmetic Art Examiners
Dental Examiners
Dietetics/Nutrition
Electrical Contractors
Electrolysis
Foresters
Geologists
Hearing Aid Dealers and Fitters
Landscape Architects
Landscape Contractors
Locksmith Licensing Board
Massage & Bodywork Therapy
Marital and Family Therapy
Medical Examiners
Midwifery Joint Committee
Mortuary Science
Nursing
Nursing Home Administrators
Occupational Therapists
Opticians
Optometry
Osteopathic Examination & Reg. (Repealed)
Pastoral Counselors, Fee-Based Practicing
Pharmacy
Physical Therapy Examiners
Plumbing, Heating & Fire Sprinkler Contractors
Podiatry Examiners
Professional Counselors
Psychology Board
Professional Engineers & Land Surveyors
Real Estate Appraisal Board
Real Estate Commission
Refrigeration Examiners
Respiratory Care Board
Sanitarian Examiners
Social Work Certification
Soil Scientists
Speech & Language Pathologists & Audiologists
Substance Abuse Professionals
Therapeutic Recreation Certification
Veterinary Medical Board
1
2
3
4
6
8
10
11
12
14
16
17
18
19
20
21
22
26
28
29
30
31
32
33
34
36
37
38
40
42
44
45
46
48
50
52
53
54
56
57
58
60
61
62
63
69
64
68
65
66
Note: Title 21 contains the chapters of the various occupational licensing boards.
NORTH CAROLINA REGISTER
Publication Schedule for July 2003 – December 2003
FILING DEADLINES NOTICE OF TEXT PERMANENT RULE TEMPORARY
RULES
Volume &
issue
number
Issue date Last day
for filing
Earliest date for
public hearing
End of required
comment
period
Deadline to submit
to RRC
for review at
next meeting
Earliest Eff.
Date of
Permanent Rule
Delayed Eff. Date of
Permanent Rule
(first legislative
day of the next
regular session)
270th day from publication
in the Register
17:13 01/02/03 12/06/02 01/17/03 03/03/03 03/20/03 05/01/03 05/10/04 09/29/03
17:14 01/15/03 12/19/02 01/30/03 03/17/03 03/20/03 05/01/03 05/10/04 10/12/03
17:15 02/03/03 01/10/03 02/18/03 04/04/03 04/21/03 06/01/03 05/10/04 10/31/03
17:16 02/17/03 01/27/03 03/04/03 04/21/03 04/21/03 06/01/03 05/10/04 11/14/03
17:17 03/03/03 02/10/03 03/18/03 05/02/03 05/20/03 07/01/03 05/10/04 11/28/03
17:18 03/17/03 02/24/03 04/01/03 05/16/03 05/20/03 07/01/03 05/10/04 12/12/03
17:19 04/01/03 03/11/03 04/16/03 06/02/03 06/20/03 08/01/03 05/10/04 12/27/03
17:20 04/15/03 03/25/03 04/30/03 06/16/03 06/20/03 08/01/03 05/10/04 01/10/04
17:21 05/01/03 04/09/03 05/16/03 06/30/03 07/21/03 09/01/03 05/10/04 01/26/04
17:22 05/15/03 04/24/03 05/30/03 07/14/03 07/21/03 09/01/03 05/10/04 02/09/04
17:23 06/02/03 05/09/03 06/17/03 08/01/03 08/20/03 10/01/03 05/10/04 02/27/04
17:24 06/16/03 05/23/03 07/01/03 08/15/03 08/20/03 10/01/03 05/10/04 03/12/04
18:01 07/01/03 06/10/03 07/16/03 09/02/03 09/22/03 11/01/03 05/10/04 03/27/04
18:02 07/15/03 06/23/03 07/30/03 09/15/03 09/22/03 11/01/03 05/10/04 04/10/04
18:03 08/01/03 07/11/03 08/16/03 09/30/03 10/20/03 12/01/03 05/10/04 04/27/04
18:04 08/15/03 07/25/03 08/30/03 10/14/03 10/20/03 12/01/03 05/10/04 05/11/04
18:05 09/02/03 08/11/03 09/17/03 11/03/03 11/20/03 01/01/04 05/10/04 05/29/04
18:06 09/15/03 08/22/03 09/30/03 11/14/03 11/20/03 01/01/04 05/10/04 06/11/04
18:07 10/01/03 09/10/03 10/16/03 12/01/03 12/22/03 02/01/04 05/10/04 06/27/04
18:08 10/15/03 09/24/03 10/30/03 12/15/03 12/22/03 02/01/04 05/10/04 07/11/04
18:09 11/03/03 10/13/03 11/18/03 01/02/04 01/20/04 03/01/04 05/10/04 07/30/04
18:10 11/17/03 10/24/03 12/02/03 01/16/04 01/20/04 03/01/04 05/10/04 08/13/04
18:11 12/01/03 11/05/03 12/16/03 01/30/04 02/20/04 04/01/04 05/10/04 08/27/04
18:12 12/15/03 11/20/03 12/30/03 02/13/04 02/20/04 04/01/04 05/10/04 09/10/04
EXPLANATION OF THE PUBLICATION SCHEDULE
This Publication Schedule is prepared by the Office of Administrative Hearings as a public service and the computation of time periods are not to be deemed binding or controlling.
Time is computed according to 26 NCAC 2C .0302 and the Rules of Civil Procedure, Rule 6.
GENERAL
The North Carolina Register shall be published twice
a month and contains the following information
submitted for publication by a state agency:
(1) temporary rules;
(2) notices of rule-making proceedings;
(3) text of proposed rules;
(4) text of permanent rules approved by the Rules
Review Commission;
(5) notices of receipt of a petition for municipal
incorporation, as required by G.S. 120-165;
(6) Executive Orders of the Governor;
(7) final decision letters from the U.S. Attorney
General concerning changes in laws affecting
voting in a jurisdiction subject of Section 5 of
the Voting Rights Act of 1965, as required by
G.S. 120-30.9H;
(8) orders of the Tax Review Board issued under
G.S. 105-241.2; and
(9) other information the Codifier of Rules
determines to be helpful to the public.
COMPUTING TIME: In computing time in the
schedule, the day of publication of the North Carolina
Register is not included. The last day of the period so
computed is included, unless it is a Saturday, Sunday,
or State holiday, in which event the period runs until
the preceding day which is not a Saturday, Sunday, or
State holiday.
FILING DEADLINES
ISSUE DATE: The Register is published on the first
and fifteen of each month if the first or fifteenth of
the month is not a Saturday, Sunday, or State holiday
for employees mandated by the State Personnel
Commission. If the first or fifteenth of any month is
a Saturday, Sunday, or a holiday for State employees,
the North Carolina Register issue for that day will be
published on the day of that month after the first or
fifteenth that is not a Saturday, Sunday, or holiday for
State employees.
LAST DAY FOR FILING: The last day for filing
for any issue is 15 days before the issue date
excluding Saturdays, Sundays, and holidays for State
employees.
NOTICE OF TEXT
EARLIEST DATE FOR PUBLIC HEARING: The
hearing date shall be at least 15 days after the date a
notice of the hearing is published.
END OF REQUIRED COMMENT PERIOD
(1) RULE WITH NON-SUBSTANTIAL
ECONOMIC IMPACT: An agency shall accept
comments on the text of a proposed rule for at least
60 days after the text is published or until the date of
any public hearings held on the proposed rule,
whichever is longer.
(2) RULE WITH SUBSTANTIAL ECONOMIC
IMPACT: An agency shall accept comments on the
text of a proposed rule published in the Register and
that has a substantial economic impact requiring a
fiscal note under G.S. 150B-21.4(b1) for at least 60
days after publication or until the date of any public
hearing held on the rule, whichever is longer.
DEADLINE TO SUBMIT TO THE RULES
REVIEW COMMISSION: The Commission shall
review a rule submitted to it on or before the
twentieth of a month by the last day of the next
month.
FIRST LEGISLATIVE DAY OF THE NEXT
REGULAR SESSION OF THE GENERAL
ASSEMBLY: This date is the first legislative day of
the next regular session of the General Assembly
following approval of the rule by the Rules Review
Commission. See G.S. 150B-21.3, Effective date of
rules.
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
344
This Section contains the text of proposed rules. The agency must accept comments on the proposed rule for at least 60 days
from the publication date, or until the public hearing, or a later date if specified in the notice by the agency. Statutory reference:
G.S. 150B-21.
TITLE 01 – DEPARTMENT OF ADMINISTRATION
Notice is hereby given in accordance with G.S. 150B-21.2 that
the State Building Commission intends to adopt the rules cites as
01 NCAC 30A .0406; 30J .0101-.0103, .0201-.0202, .0301-
.0306.
Proposed Effective Date: January 1, 2004
Public Hearing:
Date: September 30, 2003
Time: 2:00 p.m. – 4:00 p.m.
Location: State Construction Office, Conference Room, Suite
450, New Education Building, 301 N. Wilmington St., Raleigh,
NC
Reason for Proposed Action:
01 NCAC 30A .0406 – S.L. 2001-496, Sec. 11(1) (SB914)
requires the State Building Commission to adopt rules governing
review and final approval of plans submitted to the State
Construction Office pursuant to G.S. 58-31-40. Temporary rules
were adopted in February of 2003.
01 NCAC 30J .0101-.0103, .0201-.0202, .0301-.0306 – S.L.
2001-496, Sec. 11(1) (SB914) requires the State Building
Commission to adopt rules to ensure that designers, consultants
and construction managers at risk selected for State Capital
improvement projects have the necessary qualifications and
experience to complete those projects . Temporary rules were
adopted in February of 2003.
Comment Procedures: Comments from the public shall be
directed to Speros Fleggas, Director, State Construction Office,
1307 Mail Service Center, Raleigh, NC 27699-1309, phone
(919) 733-7962 and email speros.fleggas@ncmail.net.
Comment period ends November 3, 2003.
Procedure for Subjecting a Proposed Rule to Legislative
Review: Any person who objects to the adoption of a permanent
rule may submit written comments to the agency. A person may
also submit written objections to the Rules Review Commission.
If the Rules Review Commission receives written and signed
objections in accordance with G.S. 150B-21.3(b2) from 10 or
more persons clearly requesting review by the legislature and the
Rules Review Commission approves the rule, the rule will
become effective as provided in G.S. 150B-21.3(b1). The
Commission will receive written objections until 5:00 p.m. on
the 6th business day preceding the end of the month in which a
rule is approved. The Commission will receive those objections
by mail, delivery service, hand delivery, or facsimile
transmission. If you have any further questions concerning the
submission of objections to the Commission, please call a
Commission staff attorney at 919-733-2721.
Fiscal Impact
State
Local
Substantive (>$3,000,000)
None
CHAPTER 30 - STATE CONSTRUCTION
SUBCHAPTER 30A - DIVISION OF STATE
CONSTRUCTION
SECTION .0400 - CONSTRUCTION ADMINISTRATION
OFFICE
01 NCAC 30A .0406 REVIEW BY STATE
CONSTRUCTION OFFICE FOR FIRE SAFETY
REQUIREMENTS
In all cases where plans are submitted to the State Construction
Office pursuant to G.S. 58-31-40:
(1) The owner shall submit complete construction
documents to the State Construction Office in
accordance with the planning procedures in the
State Construction Manual.
(2) Pursuant to G.S. 58-31-40 (c), should an
owner request review and final approval of the
plans by the State Construction Office and the
Department of Insurance and if the plans have
not been approved by the Commissioner of
Insurance within 60 days of submittal, such
review and final approval shall be conducted
by the State Construction Office within 30
days.
(3) No type of structural work may be initiated by
the owner without prior approval of the State
Construction Office.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
SUBCHAPTER 30J - CONSTRUCTION MANAGER-AT-RISK
SELECTION PROCEDURES
SECTION .0100 – GENERAL PROVISIONS
01 NCAC 30J .0101 AUTHORITY
The State Building Commission, hereinafter referred to as SBC,
is a statutory body, empowered by public law (G.S. 143-135.26)
to perform a multiplicity of duties with regard to the State's
capital facilit ies development and management program. In the
specific area of State capital improvement project construction
manager-at-risk selection, the SBC is empowered to adopt rules
establishing standard procedures and criteria to assure that the
construction manager-at-risk selected for each State capital
improvement project has the qualifications and experience
necessary for that capital improvement project. The SBC is
responsible and accountable for the final selection of the
construction manager-at-risk. The exceptions are the University
of North Carolina and the General Assembly, which shall be
responsible and accountable for the final selection of
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
345
construction manger-at-risk for capital projects in which they are
the funded agencies.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0102 POLICY
It is the policy of the SBC to select construction manager-at-risk
for State capital improvement projects as defined in G.S. 143-
128.1, based on criteria contained herein and to make available
to every firm, duly licensed as a general contractor in the State
of North Carolina, the opportunity to be considered for
providing construction management-at-risk services for those
departments and agencies under its jurisdiction. It is also the
policy of the SBC to select a construction manager-at-risk for
State capital improvement project who is in compliance with the
minority business participation requirements as prescribed in
G.S. 143-128.2. The SBC considers that the selection of
competent construction manager-at-risk is vital to providing the
State of North Carolina with the best and most appropriate
facilities consistent with authorized funds. These procedures are
intended to provide a basis for the fair and uniform selection of
construction managers-at-risk. The construction manager-at-risk
shall use standard form of contract for the owner, construction
manager-at-risk, and first-tier subcontractor authorized by the
SBC.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0103 DEFINITIONS
For purposes of this Subchapter, the following definitions shall
apply:
(1) "Capital Projects Coordinator" means the
individual authorized by each funded agency
to coordinate all capital improvement projects
and related matters with the State Construction
Office and to represent that agency on all
matters presented to the SBC. The individual
so designated for purposes of these Rules may
have other titles within his agency but shall
carry out the duties assigned herein to the
capital projects coordinator. Whenever the
capital projects coordinator is referenced
herein, it shall be understood to include a
designated assistant or representative.
(2) "Construction Manager-at-Risk" means a
person, corporation, or entity that provides
construction management at risk services.
(3) "Construction Management-at-Risk Services"
means services provided by a person,
corporation, or entity that
(a) provides construction management
services for a project throughout the
preconstruction and construction
phases;
(b) who is licensed as a general
contractor; and
(c) who guarantees the cost of the
project.
(4) "First-Tier Subcontractor" means a
subcontractor who contracts directly with the
Construction Manager-at-Risk.
(5) "Contact person" means the person named in
the public advertisement who shall be the
Capital Projects Coordinator or his/her
designee.
(6) "Funded agency" means the department,
agency, authority or office that is named in the
legislation appropriating funds for the design
and/or construction project.
(7) "Using agency" means the subdivision of the
funded agency for whose use the project is to
be provided. If the funded agency is so
subdivided for administrative control, the
using agency would be a division,
geographically self-contained facility, campus
or similar body, as determined by the
administrative head of the funded agency.
(8) "Minority Business" means:
(a) in which at least 51 percent is owned
by one or more minority persons, or
in the case of corporation, in which at
least 51 percent of the stock is owned
by one or more minority persons or
socially and economically
disadvantaged individuals; and
(b) of which the management and daily
business operations are controlled by
one or more of the minority persons
or socially and economically
disadvantaged individuals who own
it.
(9) "Socially and economically disadvantaged
individual" means the same as defined in 15
U.S.C. 637.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
SECTION .0200 - PROJECT INFORMATION
01 NCAC 30J .0201 PROJECT DESCRIPTION
It shall be the responsibility of each Capital Projects Coordinator
to provide the State Construction Office with a written
description of the construction management-at-risk services
desired, the program or scope of work, schedule requirements,
amount of authorized funds and other appropriate information
for each project requiring construction management-at-risk
services. This information should be provided to the State
Construction Office for publication on State Construction Office
website. The Capital Projects Coordinator is responsible for
prompt initiation of the Construction Manager-at-Risk selection
process and shall make his/her best effort to enable the
completion of the selection process within 60 days of the date of
the above notification.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0202 PUBLIC ANNOUNCEMENT
Based upon project information furnished by a Capital Projects
Coordinator, the State Construction Office shall publish an
announcement of the need for construction management-at-risk
services, a designated contact person in the using agency and the
closing date on the State Construction Office website. Public
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
346
announcement is required prior to Construction Manager-at-Risk
selection. The closing date for being considered for construction
management-at-risk services shall be minimum of 21 days from
date of publication on the State Construction Office website.
Responses to RFP for each project must be received by the
Capital Project Coordinator prior to a firm's being considered for
construction management-at-risk services.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
SECTION .0300 - SELECTION OF CONSTSRUCTION
MANAGERS AT RISK
01 NCAC 30J .0301 CONSTRUCTION MANAGER-AT-
RISK QUALIFICATIONS
All firms desiring to provide construction management-at-risk
services shall submit all information required in the Request for
Proposal (RFP) for the owner's review and evaluation. Firms
shall be required to submit evidence of compliance with the
minimum requirements of the RFP. Each firm shall meet the
minimum requirements of the RFP prior to being considered by
the selection committee as one of the firms most qualified to
perform construction manager-at-risk services. Failure of any
firm to furnish all necessary information in the RFP shall
disqualify response.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0302 PRE-SELECTION COMMITTEE
A pre-selection committee shall be established for all projects
requiring construction management-at-risk services. The pre-selection
committee shall consist of at least the capital projects
coordinator, a representative of the using agency and one
representative from the State Construction Office. At least one
member of all pre-selection committees shall be a licensed
design or construction professional. The pre-selection committee
shall review the requirements of a specific project and the
qualification of all firms expressing interest in that project and
shall select from that list not more than six nor less than three
firms to be interviewed and evaluated. The pre-selection
committee shall interview each of the selected firms, evaluate
each firm interviewed, and rank in order three firms. The capital
projects coordinator shall state in his submission that the
established rules for public announcement and selection have
been followed or shall state full particulars if exceptions have
been taken.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0303 SELECTING CRITERIA
In selecting the three firms to be presented to the SBC, the pre-selection
committee should take into consideration in the
evaluation of the Proposals such factors as:
(1) Workload that is fully able to accommodate
the addition of this project;
(2) Record of successfully completed projects of
similar scope without major legal or technical
problems ;
(3) Previous experience with the Owner, a good
working relationship with Owner
representatives, have completed projects in a
timely manner and have performed an
acceptable quality of work;
(4) Key personnel that have appropriate
experience and qualifications;
(5) Relevant and easily understood graphic or
tabular presentations;
(6) Completion of CM-at-Risk projects in which
there was little differences between the GMP
and final cost;
(7) Projects that were completed on or ahead of
schedule;
(8) Recent experience with project costs and
schedules;
(9) Construction administration capabilities;
(10) Proximity to and familiarity with the area
where the project is located;
(11) Quality of compliance plan for minority
business participation as required by G.S. 143-
128.2; and
(12) Other factors that may be appropriate for the
project.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0304 CONSTRUCTION MANAGER-AT-
RISK SELECTION FOR UNC SYSTEM PROJECTS
In selecting Construction Manager-at-Risk for its projects, the
UNC system shall comply with the policies and selection
procedures outlined herein, except that:
(1) the pre-selection committees need not include
a representative of the State Construction
Office; and
(2) the final selection of Construction Manager-at-
Risk shall be made by the Board of Trustees of
the funded institution.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0305 CONSTRUCTION MANAGER-AT-
RISK SELECTION FOR OTHER THAN UNC
SYSTEM PROJECTS
Upon receipt of a letter from the capital projects coordinator
listing three firms in priority order along with recommendations
and selection information, as requested by the SBC, the secretary
of SBC, upon determination that all information has been
submitted, will place the request for consideration on the agenda
for the next SBC meeting. The capital projects coordinator shall
make a report to the SBC outlining the procedures that were
followed and justification for the priority list of three firms.
Upon a determination by the SBC that the standard procedures
and criteria have been properly followed, the SBC will:
(1) Affirm the selection of the firms in the priority
order recommended by the state or agency; or
(2) Select the firms in a different priority order
from that recommended by the funded agency
and give justification for such selection; or
(3) Request a new priority list and give
justification for such request.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
347
01 NCAC 30J .0306 CONTRACT NEGOTIATION
After the three have been notified of the selection action by the
SBC or the University of North Carolina, a representative from
the State Construction Office, the capital projects coordinator,
and a representative from the using agency shall discuss with the
selected construction manager-at-risk appropriate services and
information about the project. The State Construction Office
shall request in writing a detailed fee proposal from the selected
Construction Manager-at-Risk. The State Construction Office in
coordination with the capital projects coordinator and the using
agency will attempt to negotiate a fair and equitable fee
consistent with the project program and the professional services
required for the specific project. In the event a fee cannot be
agreed upon, the State Construction Office shall terminate the
negotiations and shall repeat the notification and negotiation
process with the next ranked firm on the selection list. In the
event a fee cannot be agreed upon with the second-ranked
Construction Manager-at-Risk, the process will be repeated with
the third-ranked Construction Manager-at-Risk. If a fee still
cannot be agreed upon, the SBC shall review the history of
negotiations and make appropriate determinations including
program adjustments so as to lead to a negotiated contract with
one of the original three firms selected. Such renegotiation with
the firms shall be carried out in the original selection order, or
call shall be made for the capital projects coordinator to submit
another list of three firms in priority order to the SBC or to the
UNC system. The negotiation process shall continue until a fee
has been determined that is agreed to by the State Construction
Office, the using agency and the Construction Manager-at-Risk.
Following execution of the contract, the State Construction
Office shall publish on the State Construction Office website,
the list of three firms selected in priority order, the firm to be
contracted with, and the fee negotiated.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
TITLE 10A – DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Notice is hereby given in accordance with G.S. 150B-21.2 that
the NC Medical Care Commission intends to amend the rule
cited as 10A NCAC 13J .1302.
Proposed Effective Date: January 1, 2004
Public Hearing:
Date: November 6, 2003
Time: 2:00 p.m.
Location: Room 201, Council Building, Dorothea Dix campus,
701 Barbour Dr. Raleigh, NC
Reason for Proposed Action: The NC Medical Care
Commission proposes to amend this Rule. This Rule pertains to
the policy/procedure for obtaining a physician's
countersignature on verbal orders. The suggested amendment
will clarify under which circumstances a physician's signature is
necessary. This action will replace and supersede an earlier
amendment to the same rule approved by the NC Medical Care
Commission and the Rules Review Commission which would be
effective July 1, 2004.
Comment Procedures: Comments from the public shall be
directed to Mark T. Benton, 2701 Mail Service Center, Division
of Facility Services, Raleigh, NC 27699-2701, phone (919) 855-
3750, fax (919) 733-2757, and email mark.benton@ncmail.net.
Comment period ends November 6, 2003.
Procedure for Subjecting a Proposed Rule to Legislative
Review: Any person who objects to the adoption of a permanent
rule may submit written comments to the agency. A person may
also submit written objections to the Rules Review Commission.
If the Rules Review Commission receives written and signed
objections in accordance with G.S. 150B-21.3(b2) from 10 or
more persons clearly requesting review by the legislature and the
Rules Review Commission approves the rule, the rule will
become effective as provided in G.S. 150B-21.3(b1). The
Commission will receive written objections until 5:00 p.m. on
the 6th business day preceding the end of the month in which a
rule is approved. The Commission will receive those objections
by mail, delivery service, hand delivery, or facsimile
transmission. If you have any further questions concerning the
submission of objections to the Commission, please call a
Commission staff attorney at 919-733-2721.
Fiscal Impact
State
Local
Substantive (>$3,000,000)
None
CHAPTER 13 – NC MEDICAL CARE COMMISSION
SUBCHAPTER 13J - THE LICENSING OF HOME CARE
AGENCIES
SECTION .1300 - PHARMACEUTICALS AND MEDICAL
TREATMENT ORDERS
10A NCAC 13J .1302 ORDERS
(a) Orders for pharmaceuticals and medical treatments
treatments, or orders for in-home aide services when orders
for in-home aide services are required, shall be signed by
the physician or other person authorized by State law to
prescribe such treatments and the original incorporated in
the client's service records. Care may commence in the
interim with evidence of a verbal order.
(b) Verbal orders for the administration of pharmacological
agents and other medical treatment interventions shall be
given to a licensed nurse, or other person authorized by state
law to receive such orders. orders recorded and signed by
the person receiving it and countersigned by the physician
or other person authorized by State law to prescribe within
30 days. The order shall include the date and signature of
the person receiving the order, shall be recorded in the client
record, and shall be countersigned by the physician or other
person authorized by State law to prescribe.
(c) Verbal orders for allied health services personnel, other
than nursing or other than in-home aide services when
orders are required, services, shall be given to either a
licensed nurse or the appropriate health professional,
recorded in the client record and signed by the person
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
348
receiving it and countersigned by the physician or other
person authorized by State law to prescribe within 30 days
from the time given. professional. The order shall include
the date and signature of the person receiving the order,
shall be recorded in the client record and shall be
countersigned by the physician or other person authorized
by State law to prescribe.
(d) The home care agency shall develop and implement
written policies and procedures for obtaining
countersignatures on verbal orders within 60 days of the
date of the verbal order.
Authority G.S. 131E-140.
* * * * * * * * * * * * * * * * * * * *
Notice is hereby given in accordance with G.S. 150B-21.2 that
the NC Medical Care Commission intends to adopt the rules
cited as 10A NCAC 13P .0121-.0122, .0201-.0202, .0301, .0501-
.0502, .0504, .0507-.0508, .0510, .0601-.0603, .0701, amend the
rules cited as 10A NCAC 13P .0101, .0106, .0114, .0119, .0203-
.0205, .0207-.0211, .0214, .0303, .0401-.0403, .0405-.0409,
.0506, .0509, .0901-.0903, .0905, .1103, and repeal the rules
cited as 10A NCAC 13P .0108, .0604, .1201-.1203, .1301.
Proposed Effective Date: January 1, 2004
Public Hearing:
Date: November 6, 2003
Time: 3:30 p.m.
Location: Division of Facility Services, Room 201, Council
Building, Dorothea Dix campus, 701 Barbour Drive, Raleigh,
NC
Reason for Proposed Action: The NC Medical Care
Commission is proposing to adopt, amend and repeal rules
found in 10A NCAC 13P. This Subchapter pertains to
Emergency Medical Services (EMS). The specifics of this rule-making
action are: (a) The changes to rules .0108, .0121-.0122,
.0201-.0202, .0301, .0501-.0502, .0504, .0507-.0508, .0601-
.0603, .0701 were prompted by SL 2003-392 (SB 661). This
legislation authorized the NC Medical Care Commission to
establish occupational standards for EMS systems, EMS
educational institutions and specialty care transport programs.
The action on these specific rules will replace and supersede
earlier action of the same rules that are pending legislative
review and would have been effective August 2004. (b) The
adoption of a new rule at 10A NCAC 13P .0510 and
amendments to existing rules 10A NCAC 13P .0101, .0106,
.0119, .0203, .0401-.0403, .0408-.0409, .0510, .1103 were also
prompted by SB 661. This legislation authorized the NC
Medical Care Commission to set the criteria for the
education/credentialing of EMS instructors, establish an "EMS
Peer Review Committee," delete the EMT-D level of care, and
remove credentialing (by the state) for MICN, EMS-PA and
EMS-NP. (c) The repeal of, and amendments to, 10A NCAC
13P .0114, .0204-.0205, .0207-.0211, .0214, .0303, .0405-.0407,
.0506, .0509, .0604, .0901-.0903, .0905, .1201-.1203 and .1301
were not prompted by SB 661. Rather, these changes are
technical in nature and are limited to removing
transitional/dated material, inserting abbreviations, etc.
Comment Procedures: Written comments should be submitted
to Mark Benton, NC Division of Facility Services, 2701 MSC,
Raleigh, NC 27699-2701. Phone: (919) 855-3750, fax: (919)
733-2757, email: mark.benton@ncmail.net. Comments should
be submitted through November 6, 2003.
Procedure for Subjecting a Proposed Rule to Legislative
Review: Any person who objects to the adoption of a permanent
rule may submit written comments to the agency. A person may
also submit written objections to the Rules Review Commission.
If the Rules Review Commission receives written and signed
objections in accordance with G.S. 150B-21.3(b2) from 10 or
more persons clearly requesting review by the legislature and the
Rules Review Commission approves the rule, the rule will
become effective as provided in G.S. 150B-21.3(b1). The
Commission will receive written objections until 5:00 p.m. on
the 6th business day preceding the end of the month in which a
rule is approved. The Commission will receive those objections
by mail, delivery service, hand delivery, or facsimile
transmission. If you have any further questions concerning the
submission of objections to the Commission, please call a
Commission staff attorney at 919-733-2721.
Fiscal Impact
State
Local
Substantive (>$3,000,000)
None
CHAPTER 13 – FACILITY SERVICES
SUBCHAPTER 13P – EMERGENCY MEDICAL
SERVICES
SECTION .0100 - DEFINITIONS
10A NCAC 13P .0101 ABBREVIATIONS
As used in this Subchapter, the following abbreviations mean:
(1) AHA: American Heart Association;
(2) CPR: Cardiopulmonary Resuscitation.
(3) EMD: Emergency Medical Dispatcher;
(4) EMDPRS: Emergency Medical Dispatch
Priority Reference System;
(5) EMS: Emergency Medical Services;
(6) EMS-NP: EMS Nurse Practitioner;
(7) EMS-PA: EMS Physician Assistant;
(8) EMT: Emergency Medical Technician;
(9) EMT-D: EMT-Defibrillation;
(10)(9) EMT-I: EMT-Intermediate;
(11)(10) EMT-P: EMT-Paramedic;
(12)(11) MICN: Mobile Intensive Care Nurse;
(13)(12) MR: Medical Responder; and
(13) NHTSA: National Highway Traffic Safety
Administration
(14) OEMS: Office of Emergency Medical
Services; and
(15) US DOT: United States Department of
Transportation.
Authority G.S. 143-508(b).
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
349
10A NCAC 13P .0106 EDUCATIONAL MEDICAL
ADVISOR
As used in this Subchapter, "Educational Medical Advisor"
means the physician responsible for overseeing the medical
components of approved EMS educational programs in
continuing education, basic, and advanced EMS educational
institutions.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13).
10A NCAC 13P .0108 EMS INSTRUCTOR
"EMS Instructor" means a person who is credentialed by the
OEMS as a Level I or II EMS Instructor or EMD Instructor and
who is approved to instruct or coordinate EMS educational
programs.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(4);
131E-155(a)(7a).
10A NCAC 13P .0114 MEDICAL OVERSIGHT
As used in this Subchapter, "Medical Oversight" means the
responsibility for the management and accountability of the
medical care aspects of an EMS System. System or Specialty
Care Transport Program. Medical Oversight includes physician
direction of the initial education and continuing education of
EMS personnel;personnel or medical crew members;
development and monitoring of both operational and treatment
protocols; evaluation of the medical care rendered by EMS
personnel;personnel or medical crew members; participation in
system or program evaluation; and directing, by two-way voice
communications, the medical care rendered by the EMS
personnel.personnel or medical crew members.
Authority G.S. 143-508(b).
10A NCAC 13P .0119 EMS PEER REVIEW
COMMITTEE
As used in this Subchapter, "Quality Management""EMS Peer
Review Committee" means a committee as defined in G.S.
131E-155(a)(16a).within an EMS System or Specialty Care
Transport Program that is affiliated with a medical review
committee as referenced in G.S. 143-518(a)(5) and is
responsible for the continued monitoring and evaluation of
medical and operational issues within the system and for
improvement of the system.
Authority G.S. 143-508(b); 143-518(a)(5); 131E-155(a)(16a).
10A NCAC 13P .0121 SPECIALTY CARE TRANSPORT
PROGRAM CONTINUING EDUCATION
COORDINATOR
As used in this Subchapter, "Specialty Care Transport Program
Continuing Education Coordinator" means a Level I EMS
Instructor within a specialty care transport program who is
responsible for the coordination of EMS continuing education
programs for EMS personnel within the program.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13).
10A NCAC 13P .0122 SYSTEM CONTINUING
EDUCATION COORDINATOR
As used in this Subchapter, "System Continuing Education
Coordinator" means a Level I EMS Instructor within a Model
EMS System who is responsible for the coordination of EMS
continuing education programs.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13).
SECTION .0200 – EMS SYSTEMS
10A NCAC 13P .0201 EMS SYSTEM REQUIREMENTS
(a) County government shall establish EMS Systems . Each
EMS System shall have:
(1) a defined geographical service area for the
EMS System. The minimum service area for
an EMS System shall be one county. There
may be multiple EMS provider service areas
within the service area of an EMS System.
The highest level of care offered within any
EMS provider service area must be available
to the citizens within that service area 24 hours
per day;
(2) a scope of practice within the parameters
defined by the North Carolina Medical Board
pursuant to G.S. 143-514;
(3) a written plan describing the dispatch and
coordination of all responders that provide
EMS care within the system;
(4) a minimum of one licensed EMS provider.
For those systems with providers operating
within the EMD, EMT-I, or EMT-P scope of
practice, there shall be a plan for medical
oversight required by Section .0400 of this
Subchapter;
(5) an identified number of permitted ambulances
to provide coverage to the service area 24
hours per day;
(6) personnel credentialed to perform within the
scope of practice of the system and to staff the
ambulance vehicles as required by G.S. 131E-
158. There shall be a written plan for the use
of credentialed EMS personnel for all practice
settings used within the system;
(7) a mechanism to collect and electronically
submit to the OEMS data that uses the basic
data set and data dictionary as specified in
"North Carolina College of Emergency
Physicians: Standards for Medical Oversight
and Data Collection," incoporated by reference
in accordance with G.S. 150B-21.6, including
subsequent amendments and additions. This
document is available from the OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost. EMS Systems shall
comply with this requirement by July 1, 2004;
(8) a written infection control policy that
addresses the cleansing and disinfecting of
vehicles and equipment that are used to treat or
transport patients;
(9) a written plan to provide orientation to
personnel on EMS operations and related
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
350
issues for hospitals routinely receiving patients
from the EMS System;
(10) a listing of facilities that will provide online
medical direction for systems with providers
operating within the EMT, EMT-I, or EMT-P
scope of practice. To provide online medical
direction, the facility shall have:
(A) availability of a physician, MICN,
EMS-NP, or EMS-PA to provide
online medical direction to EMS
personnel during all hours of
operation of the facility;
(B) a written plan to provide physician
backup to the MICN, EMS-NP, or
EMS-PA providing online medical
direction to EMS personnel;
(C) a mechanism for persons providing
online medical direction to provide
feedback to the EMS Peer Review
Committee; and
(D) a written plan to provide orientation
and education regarding treatment
protocols for those individuals
providing online medical direction;
(11) a written plan to ensure that each facility
which routinely receives patients and also
offers clinical education for EMS personnel
provides orientation and education to all
preceptors regarding requirements of the EMS
System;
(12) a written plan for providing emergency vehicle
operation education for system personnel who
operate emergency vehicles;
(13) an EMS communication system that provides
for:
(A) public access using the emergency
telephone number 9-1-1 within the
public dial telephone network as the
primary method for the public to
request emergency assistance. This
number shall be connected to the
emergency communications center or
Public Safety Answering Point
(PSAP) with immediate assistance
available such that no caller will be
instructed to hang up the telephone
and dial another telephone number.
A person calling for emergency
assistance shall never be required to
speak with more than two persons to
request emergency medical
assistance;
(B) an emergency communications
system operated by public safety
telecommunicators with training in
the management of calls for medical
assistance available 24 hours per day;
(C) dispatch of the most appropriate
emergency medical response unit or
units to any caller's request for
assistance. The dispatch of all
response vehicles shall be in
accordance with an official written
EMS System plan for the
management and deployment of
response vehicles including requests
for mutual aid; and
(D) two-way radio voice communications
from within the defined service area
to the emergency communications
center or PSAP and to facilities where
patients are routinely transported.
The emergency communications
system shall maintain all Federal
Communications Commission (FCC)
radio licenses or authorizations
required;
(14) a written plan addressing the use of Specialty
Care Transport Programs within the system;
(15) a written continuing education plan for
credentialed EMS personnel that follows the
guidelines of the:
(A) "US DOT NHTSA First Responder
Refresher: National Standard
Curriculum" for MR personnel;
(B) "US DOT NHTSA EMT-Basic
Refresher: National Standard
Curriculum" for EMT personnel;
(C) "EMT-P and EMT-I Continuing
Education National Guidelines" for
EMT-I and EMT-P personnel; and
(D) "US DOT NHTSA Emergency
Medical Dispatcher: National
Standard Curriculum" for EMD
personnel.
These documents are incoporated by reference
in accordance with G.S. 150B-21.6, including
subsequent amendments and additions. These
documents are available from NHTSA, 400
7th Street, SW, Washington, D.C. 20590, at no
cost; and
(16) a written plan addressing the orientation of
MICN, EMS-NP, or EMS-PA used in the
system. The orientation program shall include
the following:
(A) a discussion of all EMS System
treatment protocols and procedures;
(B) an explanation of the specific scope
of practice for credentialed EMS
personnel, as authorized by the
approved treatment protocols;
(C) a discussion of all practice settings
within the EMS System and how
scope of practice may vary in each
setting;
(D) a mechanism to assess the student's
ability to effectively use EMS System
communications equipment including
hospital and prehospital devices,
EMS communication protocols, and
communications contingency plans as
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
351
related to on-line medical direction;
and
(E) the successful completion of a scope
of practice evaluation administered
under the direction of the medical
director.
(b) An application to establish an EMS System shall be
submitted by the county to the OEMS for review. When the
system is comprised of more than one county, only one
application shall be submitted. The proposal shall demonstrate
that the system meets the requirements in Paragraph (a) of this
Rule. System approval shall be granted for a period of six years.
Systems shall apply to OEMS for reapproval.
Authority G.S. 131E-155(a)(8), (a)(9), (a)(15);
143-508(b); (d)(1), (d)(5), (d)(9); 143-509(1); 143-517.
10A NCAC 13P .0202 MODEL EMS SYSTEMS
(a) Some EMS Systems may choose to move beyond the
minimum requirements in Rule .0201 of this Section and receive
designation from the OEMS as a Model EMS System. To
receive this designation, an EMS System shall document that, in
addition to the system requirements in Rule .0201 of this
Section, the following criteria have been met:
(1) a uniform level of care throughout the system
available 24 hours per day;
(2) a plan for medical oversight that meets the
requirements found in Section .0400 of this
Subchapter. Specifically, Model EMS
Systems shall meet the additional requirements
for medical director and written treatment
protocols as defined in Rules .0401(1)(b) and
.0405(a)(2) of this Subchapter;
(3) a mechanism to collect and electronically
submit to the OEMS data corresponding to the
advanced data set and data dictionary as
specified in "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incoporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
additions. This document is available from the
OEMS, 2707 Mail Service Center, Raleigh,
North Carolina 27699-2707, at no cost;
(4) a written plan to address management of the
EMS System to include:
(A) triage of patients to appropriate
facilities;
(B) transport of patients to facilities
outside of the system;
(C) arrangements for transporting patients
to appropriate facilities when
diversion or bypass plans are
activated;
(D) a mechanism for reporting,
monitoring, and establishing
standards for system response times;
(E) a disaster plan; and
(F) a mass-gathering plan;
(5) a written continuing education plan for EMS
personnel, under the direction of the System
Continuing Education Coordinator, developed
and modified based on feedback from system
data, review, and evaluation of patient
outcomes and quality management reviews;
(6) a written plan to assure participation in clinical
and field internship educational components
for all EMS personnel;
(7) operational protocols for the management of
equipment, supplies and medications. These
protocols shall include a methodology:
(A) to assure that each vehicle contains
the required equipment and supplies
on each response;
(B) for cleaning and maintaining the
equipment and vehicles; and
(C) to assure that supplies and
medications are not used beyond the
expiration date and stored in a
temperature controlled atmosphere
according to manufacturer's
specifications;
(8) a written plan for the systematic and periodic
inspection, repair and maintenance of all
vehicles used in the system;
(9) a written plan addressing the role of the EMS
System in the areas of public education, injury
prevention, and community health;
(10) affiliation with a minimum of one trauma
Regional Advisory Committee; and
(11) a system-wide communication system which
meets the requirements of Paragraph (a)(13) of
Rule .0201 of this Section, and in addition:
(A) operates an EMD program; and
(B) has an operational E-911 system.
(b) EMS Systems holding current accreditation by a national
accreditation agency may use this as documentation of
completion of the equivalent requirements outlined in this Rule.
(c) The county shall submit an application for designation as a
Model EMS System to the OEMS for review. When the system
is comprised of more than one county, only one application shall
be submitted. The application shall demonstrate that the system
meets the standards found in Paragraph (a) of this Rule.
Designation as a Model EMS System shall be awarded for a
period of six years. Systems shall apply to OEMS for model
system redesignation.
Authority G.S. 143-508(b); (d)(1), (d)(5), (d)(9); (d)(13);
143-509(1).
10A NCAC 13P .0203 SPECIAL SITUATIONS
Upon application of citizens in North Carolina, the North
Carolina Medical Care Commission shall approve the furnishing
and providing of programs within the scope of practice of EMD,
EMT, EMT-D, EMT-I, or EMT-P in North Carolina by persons
who have been approved to provide these services by an agency
of a state adjoining North Carolina or federal jurisdiction. This
approval shall be granted where the North Carolina Medical
Care Commission concludes that the requirements enumerated in
Rule .0201 of this Subchapter cannot be reasonably obtained by
reason of lack of geographical access.
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
352
Authority G.S. 143-508(b).
10A NCAC 13P .0204 EMS PROVIDER LICENSE
REQUIREMENTS
(a) Any firm, corporation, agency, organization or association
that provides emergency medical services as its primary
responsibility shall be licensed as an EMS providerProvider by
meeting the following criteria:
(1) Be affiliated with an EMS System. System;
Providers that apply for an initial EMS
Provider License shall have until July 1, 2003,
to comply with this requirement in the absence
of an approved county system plan. Providers
that apply for an initial EMS Provider License
after July 1, 2003, shall comply with all
requirements of this Rule;
(2) Present an application for a permit for any
ambulance that will be in service as required
by G.S. 131E-156;
(3) Submit a written plan detailing how the
providerProvider will furnish credentialed
personnel;
(4) Where there is a franchise ordinance in effect
which covers the proposed service area, be
granted a current franchise to operate or
present written documentation of impending
receipt of a franchise from the county; and
(5) Present a written plan and method for
recording systematic, periodic inspection
repair, cleaning, and routine maintenance of all
EMS responding vehicles.
(b) An EMS providerProvider may renew its license by
presenting documentation to the OEMS that the
providerProvider meets the criteria found in Paragraph (a) of this
Rule.
Authority G.S. 131E-155.1(c).
10A NCAC 13P .0205 EMS PROVIDER LICENSE
CONDITIONS
(a) Applications for an EMS Provider License must be received
by the OEMS at least 30 days prior to the date that the
providerProvider proposes to initiate service. Applications for
renewal of an EMS Provider License must be received by the
OEMS at least 30 days prior to the expiration date of the current
license.
(b) Only one license shall be issued to each EMS
provider.Provider. The Department shall issue a license to the
EMS providerProvider following verification of compliance
with applicable laws and rules.
(c) EMS Provider Licenses shall not be transferred.
(d) The license shall be posted in a prominent location
accessible to public view at the primary business location of the
EMS provider.Provider.
(e) In order to provide a transition time for implementation of
this Rule, EMS Provider Licenses obtained prior to the approval
of the EMS System Plan for the county or counties served by the
provider shall remain current until such time as the EMS System
Plan is approved.
Authority G.S. 131E-155.1(c).
10A NCAC 13P .0207 GROUND AMBULANCE:
VEHICLE AND EQUIPMENT REQUIREMENTS
(a) To be permitted as a Ground Ambulance, a vehicle shall
have:
(1) a patient compartment that meets the following
minimum interior dimensions:
(A) the length, measured on the floor
from the back of the driver's
compartment, driver's seat or partition
to the inside edge of the rear loading
doors, shall be at least 102 inches;
and
(B) the height shall be at least 48 inches
over the patient area, measured from
the approximate center of the floor,
exclusive of cabinets or equipment;
(2) patient care equipment and supplies as defined
in the treatment protocols for the system.
Vehicles used by EMS providers that are not
required to have treatment protocols shall have
patient care equipment and supplies as defined
in the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight
and Data Collection," incorporated by
reference in accordance with G.S. 150B-21.6,
including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost. The
equipment and supplies shall be clean, in
working order, and secured in the vehicle;
(3) other equipment to include:
(A) one fire extinguisher mounted in a
quick release bracket that shall either
be a dry chemical or all-purpose type
and have a pressure gauge; and
(B) the availability of one pediatric
restraint device to safely transport
pediatric patients under 20 pounds in
the patient compartment of the
ambulance;
(4) the name of the ambulance provider
permanently displayed on each side of the
vehicle;
(5) reflective tape affixed to the vehicle such that
there is reflectivity on all sides of the vehicle;
(6) emergency warning lights and audible warning
devices mounted on the vehicle as required by
G.S. 20-125 in addition to those required by
Federal Motor Vehicle Safety Standards. All
warning devices shall function properly;
(7) no structural or functional defects that may
adversely affect the patient, the EMS
personnel, or the safe operation of the vehicle;
(8) an operational two-way radio that shall:
(A) be mounted to the ambulance and
installed for safe operation and
controlled by the ambulance driver;
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
353
(B) have sufficient range, radio
frequencies, and capabilities to
establish and maintain two-way voice
radio communication from within the
defined service area of the EMS
System to the emergency
communications center or public
safety answering point (PSAP)
designated to direct or dispatch the
deployment of the ambulance;
(C) be capable of establishing two-way
voice radio communication from
within the defined service area to the
emergency department of the
hospital(s) where patients are
routinely transported and to facilities
that provide on-line medical direction
to EMS personnel;
(D) be equipped with a radio control
device mounted in the patient
compartment capable of operation by
the patient attendant to receive on-line
medical direction; and
(E) be licensed or authorized by the
Federal Communications
Commission (FCC).
(b) Ground ambulances shall not use a radiotelephone device
such as a cellular telephone as the only source of two-way radio
voice communication.
(c) Other communication instruments or devices such as data
radio, facsimile, computer, or telemetry radio shall be in addition
to the mission dedicated dispatch radio and shall function
independently from the mission dedicated radio.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0208 CONVALESCENT
AMBULANCE: VEHICLE AND EQUIPMENT
REQUIREMENTS
(a) To be permitted as a Convalescent Ambulance, a vehicle
shall have:
(1) a patient compartment that meets the following
minimum interior dimensions:
(A) the length, measured on the floor
from the back of the driver's
compartment, driver's seat or partition
to the inside edge of the rear loading
doors, shall be at least 102 inches;
and
(B) the height shall be at least 48 inches
over the patient area, measured from
the approximate center of the floor,
exclusive of cabinets or equipment;
(2) patient care equipment and supplies as defined
in the treatment protocols for the system.
Vehicles used by EMS providers that are not
required to have treatment protocols shall have
patient care equipment and supplies as defined
in the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight
and Data Collection," incorporated by
reference in accordance with G.S. 150B-21.6,
including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost. The
equipment and supplies shall be clean, in
working order, and secured in the vehicle;
(3) other equipment to include:
(A) one fire extinguisher mounted in a
quick release bracket that shall either
be a dry chemical or all-purpose type
and have a pressure gauge; and
(B) the availability of one pediatric
restraint device to safely transport
pediatric patients under 20 pounds in
the patient compartment of the
ambulance.
(b) Convalescent Ambulances shall:
(1) not be equipped, permanently or temporarily,
with any emergency warning devices, audible
or visual, other than those required by Federal
Motor Vehicle Safety Standards;
(2) have the name of the ambulance provider
permanently displayed on each side of the
vehicle;
(3) not have emergency medical symbols, such as
the Star of Life, block design cross, or any
other medical markings, symbols, or emblems,
including the word "EMERGENCY," on the
vehicle;
(4) have the words "CONVALESCENT
AMBULANCE" lettered on both sides and on
the rear of the vehicle body; and
(5) have reflective tape affixed to the vehicle such
that there is reflectivity on all sides of the
vehicle.
(c) A two-way radio or radiotelephone device such as a cellular
telephone shall be available to summon emergency assistance
for a vehicle permitted as a convalescent ambulance.
(d) The convalescent ambulance shall not have structural or
functional defects that may adversely affect the patient, the EMS
personnel, or the safe operation of the vehicle.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0209 AIR MEDICAL AMBULANCE:
VEHICLE AND EQUIPMENT REQUIREMENTS
To be permitted as an Air Medical Ambulance, an aircraft shall
meet the following requirements:
(1) Configuration of the aircraft interior shall not
compromise the ability to provide appropriate
care or prevent providers from performing
emergency procedures if necessary.
(2) The aircraft shall have on board patient care
equipment and supplies as defined in the
treatment protocols for the program. Air
Medical Ambulances used by EMS providers
that are not required to have treatment
protocols shall have patient care equipment
and supplies as defined in the "North Carolina
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
354
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection,"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the Office of Emergency
Medical Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost. The equipment and supplies shall
be clean, in working order, and secured in the
vehicle.
(3) There shall be installed in the aircraft an
internal voice communication system to allow
for communication between the medical crew
and flight crew.
(4) Due to the different configurations and space
limitations of air medical ambulances, the
medical director shall designate the
combination of medical equipment specified in
Item (2) of this Rule that is carried on a
mission based on anticipated patient care
needs.
(5) Air Medical Ambulances shall have the name
of the organization permanently displayed on
each side of the aircraft.
(6) Air Medical Ambulances shall be equipped
with a two-way voice radio licensed by the
Federal Communications Commission capable
of operation on any frequency required to
allow communications with public safety
agencies such as fire departments, police
departments, ambulance and rescue units,
hospitals, and local government agencies
within the defined service area.
(7) All rotary wing aircraft permitted as an air
medical ambulance shall have the following
flight equipment operational in the aircraft:
(a) Twotwo 360-channel VHF aircraft
frequency transceivers;
(b) Oneone VHF omnidirectional ranging
(VOR) receiver;
(c) Attitudeattitude indicators;
(d) Oneone transponder with 4097 code,
Mode C with altitude encoding;
(e) Turnturn and slip indicator in the
absence of three attitude indicators;
(f) Currentcurrent FAA approved
navigational aids and charts for the
area of operations;
(g) Radarradar altimeter;
(h) Satellite Global Navigational System;
(i) Emergency Locator Transmitter
(ELT);
(j) Aa remote control external search
light;
(k) Aa light which illuminates the tail
rotor;
(l) Aa fire extinguisher; and
(m) Survivalsurvival gear appropriate for
the service area and the number of
occupants.
(8) Any fixed wing aircraft issued a permit to
operate as an air medical ambulance shall have
a current "Instrument Flight Rules"
certification.
(9) The availability of one pediatric restraint
device to safely transport pediatric patients
under 20 pounds in the patient compartment of
the air medical ambulance.
(10) The Air Medical Ambulance shall not have
structural or functional defects that may
adversely affect the patient, the EMS
personnel, or the safe operation of the aircraft.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0210 WATER AMBULANCE:
WATERCRAFT AND EQUIPMENT REQUIREMENTS
To be permitted as a Water Ambulance, a watercraft shall meet
the following requirements:
(1) The watercraft shall have a patient care area
that:
(a) provides access to the head, torso,
and lower extremities of the patient
while providing sufficient working
space to render patient care;
(b) is covered to protect the patient and
EMS personnel from the elements;
and
(c) has an opening of sufficient size to
permit the safe loading and unloading
of a person occupying a litter.
(2) The watercraft shall have on board patient care
equipment and supplies as defined in the
treatment protocols for the system. Water
ambulances used by EMS providers that are
not required to have treatment protocols shall
have patient care equipment and supplies as
defined in the "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost. The
equipment and supplies shall be clean, in
working order, and secured in the vehicle.
(3) Water ambulances shall have the name of the
ambulance provider permanently displayed on
each side of the watercraft.
(4) Water ambulances shall have a 360-degree
beacon warning light in addition to warning
devices required in Chapter 75A, Article 1, of
the North Carolina General Statutes.
(5) Water ambulances shall be equipped with:
(a) two floatable rigid long backboards
with proper accessories for securing
infant, pediatric, and adult patients
and stabilization of the head and
neck;
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
355
(b) one floatable litter with patient
restraining straps and capable of
being secured to the watercraft;
(c) one fire extinguisher mounted in a
quick release bracket that shall either
be a dry chemical or all-purpose type
and have a pressure gauge;
(d) lighted compass;
(e) radio navigational aids such as ADF
(automatic directional finder),
Satellite Global Navigational System,
navigational radar, or other
comparable radio equipment suited
for water navigation;
(f) marine radio; and
(g) the availability of one pediatric
restraint device to safely transport
pediatric patients under 20 pounds in
the patient compartment of the
ambulance;
(6) The water ambulance shall not have structural
or functional defects that may adversely affect
the patient, the EMS personnel, or the safe
operation of the watercraft.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0211 AMBULANCE PERMIT
CONDITIONS
(a) An EMS provider shall apply to the OEMS for the
appropriate Ambulance Permit prior to placing an ambulance in
service.
(b) The Department shall issue a permit for an ambulance
following verification of compliance with applicable laws and
rules.
(c) Only one Ambulance Permit shall be issued for each
ambulance.
(d) An ambulance shall be permitted in only one category.
(e) Ambulance Permits shall not be transferred except in the
case of Air Medical Ambulance replacement aircraft when the
primary aircraft is out of service.
(f) The Ambulance Permit shall be posted as designated by the
OEMS inspector.
(g) In order to provide a transition time for implementation of
this Rule, Ambulance Permits obtained prior to the approval of
the EMS System Plan for the county or counties served by the
provider shall remain current until such time as the EMS System
Plan is approved.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0214 EMS NONTRANSPORTING
VEHICLE PERMIT CONDITIONS
(a) An EMS provider shall apply to the OEMS for an EMS
Nontransporting Vehicle Permit prior to placing such a vehicle
in service.
(b) The Department shall issue a permit for a vehicle following
verification of compliance with applicable laws and rules.
(c) Only one EMS Nontransporting Vehicle Permit shall be
issued for each vehicle.
(d) EMS Nontransporting Vehicle Permits shall not be
transferred.
(e) The EMS Nontransporting Vehicle Permit shall be posted as
designated by the OEMS inspector.
(f) In order to provide a transition time for implementation of
this Rule, EMS Nontransporting Vehicle Permits obtained prior
to the approval of the EMS System Plan for the county or
counties served by the provider shall remain current until such
time as the EMS System Plan is approved.
Authority G.S. 143-508(d)(8).
SECTION .0300 – SPECIALTY CARE TRANSPORT
PROGRAMS
10A NCAC 13P .0301 PROGRAM CRITERIA
(a) Programs seeking designation to provide specialty care
transports shall submit an application for program approval to
the OEMS at least 60 days prior to field implementation. The
application shall document that the program has:
(1) a defined service area;
(2) a medical oversight plan meeting the
requirements of Section .0400;
(3) service continuously available on a 24 hour
per day basis;
(4) the capability to provide the following patient
care skills and procedures:
(A) advanced airway techniques including
rapid sequence induction,
cricothyrotomy, and ventilator
management, including continuous
monitoring of the patient's
oxygenation;
(B) insertion of femoral lines;
(C) maintaining invasive monitoring
devices to include central venous
pressure lines, arterial and venous
catheters, arterial lines, intra-ventricular
catheters, and epidural
catheters; and
(D) interpreting 12-lead
electrocardiograms;
(5) a written continuing education plan for EMS
personnel, under the direction of the Specialty
Care Transport Program Continuing Education
Coordinator, developed and modified based on
feedback from program data, review and
evaluation of patient outcomes, and quality
management reviews; and
(6) a system to collect and submit by facsimile or
other electronic mans to the OEMS data that
uses the basic data set and data dictionary as
specified in "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
editions. This document is available from the
OEMS, 2707 Mail Service Center, Raleigh,
North Carolina 27699-2707, at no cost. EMS
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
356
Specialty Care Transport Programs shall
comply with this requirement by July 1, 2004.
(b) Applications for specialty care transport program approval
shall document that the applicant meets the requirements for the
specific program type or types applied for as specified in Rules
.0302, .0303 or .0304 of this Section.
(c) Specialty care transport program approval shall be valid for
a period to coincide with the EMS Provider License, not to
exceed six years. Programs shall apply to the OEMS for
reapproval.
Authority G.S. 143-508(d)(1), (d)(8), (d)(9); (d)(13).
10A NCAC 13P .0303 GROUND SPECIALTY CARE
TRANSPORT PROGRAMS
(a) When transporting patients that have a medical need for one
or more of the skills or procedures as defined for specialty care
transport programs in .0301(a)(4) of this Section, staffing for the
vehicle used in the ground specialty care transport program shall
be at a level to ensure the capability to provide in the patient
compartment, when the patient condition requires, two of the
following personnel approved by the medical director as medical
crew members:
(1) EMT-Paramedic;
(2) Nursenurse practitioner;
(3) Physician;physician
(4) Physicianphysician assistant;
(5) Registeredregistered nurse; and
(6) Respiratoryrespiratory therapist.
(b) When transporting patients that do not require specialty care
transport skills or procedures, staffing for the vehicles used in
the ground specialty care transport program shall be at a level to
ensure compliance with G.S. 131E-158(a).
(c) In addition to the general requirements of specialty care
transport programs in Rule .0301 of this Section, ground
programs providing specialty care transports shall document that
the program has:
(1) a communication system that will provide, at a
minimum, two-way voice communications to
medical crewmemberscrew members
anywhere in the service area of the program.
The medical director shall verify that the
communications system is satisfactory for on-line
medical direction;
(2) medical crewmemberscrew members that have
all completed training regarding:
(A) operation of the EMS
communications system used in the
program; and
(B) the medical and safety equipment
specific to the vehicles used in the
program. This training shall be
conducted every six months;
(3) Operationaloperational protocols for the
management of equipment, supplies and
medications. These protocols shall include:
(A) Aa standard equipment and supply
listing for all ambulance vehicles
used in the program. This listing
shall meet or exceed the requirements
for each category of ambulance used
in the program as found in Rules
.0207, .0208, .0209, and .0210 of this
Subchapter;
(B) Aa standard listing of medications for
all ambulance and EMS
nontransporting vehicles used in the
system. This listing shall be based on
the local treatment protocols and be
approved by the medical director;
(C) Aa methodology to assure that each
vehicle contains the required
equipment and supplies on each
response;
(D) Aa methodology for cleaning and
maintaining the equipment and
vehicles; and
(E) Aa methodology for assuring that
supplies and medications are not used
beyond the expiration date and stored
in a temperature controlled
atmosphere according to
manufacturer's specifications;
(4) Aa written plan for providing emergency
vehicle operation education for program
personnel who operate emergency vehicles;
and
(5) Aa written plan specifying how EMS Systems
will request ambulances operated by the
program.
(d) Ground Specialty Care Transport programs based outside of
North Carolina may be granted approval by the OEMS to
operate in North Carolina by submitting an application for
program approval. The application shall document that the
program meets all criteria specified in Rules .0204 and .0301 of
this Subchapter and Paragraphs (a) and (b) of this Rule.
Authority G.S. 143-508(d)(1), (d)(8), (d)(9).
SECTION .0400 -- MEDICAL OVERSIGHT
10A NCAC 13P .0401 COMPONENTS OF MEDICAL
OVERSIGHT FOR EMS SYSTEMS
Each EMS System operating within the scope of practice for
EMD, EMT-D, EMT-I, or EMT-P or seeking designation as a
Model EMS System shall have the following components in
place to assure medical oversight of the system:
(1) Aa medical director appointed, either directly
or by documented delegation, by the county
responsible for establishing the EMS System.
Systems may elect to appoint one or more
assistant medical directors.
(a) For EMS Systems, the medical
director and assistant medical
directors shall meet the criteria as
defined in the "North Carolina
College of Emergency Physicians:
Standards for Medical Oversight and
Data Collection," incorporated by
reference in accordance with G.S.
150B-21.6, including subsequent
amendments and editions. This
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
357
document is available from the Office
of Emergency Medical
Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina
27699-2707, at no cost; and
(b) For Model EMS Systems, the medical
director and assistant medical
directors shall also meet the
additional criteria for medical
directors of Model EMS Systems as
defined in the "North Carolina
College of Emergency Physicians:
Standards for Medical Oversight and
Data Collection," incorporated by
reference in accordance with G.S.
150B-21.6, including subsequent
amendments and editions. This
document is available from the Office
of Emergency Medical
Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina
27699-2707, at no cost;
(2) Writtenwritten treatment protocols for use by
EMS personnel;
(3) Forfor systems providing EMD service, an
EMDPRS approved by the medical director;
(4) A quality management committee;an EMS
Peer Review Committee; and
(5) Writtenwritten procedures for use by EMS
personnel to obtain on-line medical direction.
On-line medical direction shall:
(a) Bebe restricted to medical orders that
fall within the scope of practice of the
EMS personnel and within the scope
of approved system treatment
protocols;
(b) Bebe provided only by physicians, a
physician, MICN, EMS-NP, or EMS-PA.
EMS-physician assistants, EMS-nurse
practitioners, or mobile
intensive care nurses. Only
physicians may deviate from written
treatment protocols; and
(c) Bebe provided by a system of two-way
voice communication that can be
maintained throughout the treatment
and disposition of the patient.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0402 COMPONENTS OF MEDICAL
OVERSIGHT FOR SPECIALTY CARE TRANSPORT
PROGRAMS
Each Specialty Care Transport Program shall have the following
components in place to assure Medical Oversight of the system:
(1) Aa medical director. The administration of the
Specialty Care Transport Program shall
appoint a medical director following the
criteria for medical directors of Specialty Care
Transport Programs as defined by the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the Office of
Emergency Medical Services,OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost. The program
administration may elect to appoint one or
more assistant medical directors;
(2) Treatmenttreatment protocols for use by
medical crew members;
(3) A quality management committee;an EMS
Peer Review Committee; and
(4) Aa written protocol for use by medical crew
members to obtain on-line medical direction.
On-line medical direction shall:
(a) Bebe restricted to medical orders that
fall within the scope of practice of the
medical crew members and within the
scope of approved program treatment
protocols;
(b) Bebe provided only by physicians, a
physician, MICN, EMS-NP, or EMS-PA.
EMS-physician assistants, EMS-nurse
practitioners, or mobile
intensive care nurses. Only
physicians may deviate from written
treatment protocols; and
(c) Be obtained viabe provided by a
system of two-way voice
communication that can be
maintained throughout the treatment
and disposition of the patient.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0403 RESPONSIBILITIES OF THE
MEDICAL DIRECTOR FOR EMS SYSTEMS
(a) The medical directorMedical Director for an EMS
systemSystem shall be responsible for the following:
(1) Ensureensure that medical control is available
24 hours a day;
(2) Thethe establishment, approval and annual
updating of treatment protocols;
(3) For EMD programs, the establishment,
approval, and annual updating of the
EMDPRS;
(4) Medicalmedical supervision of the selection,
system orientation, continuing education and
performance of EMS personnel;
(5) Medicalmedical supervision of a scope of
practice performance evaluation for all EMS
personnel in the system based on the treatment
protocols for the system;
(6) Thethe medical review of the care provided to
patients;
(7) Providingproviding guidance regarding
decisions about the equipment, medical
supplies, and medications that will be carried
on ambulances or EMS nontransporting
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18:05 NORTH CAROLINA REGISTER September 2, 2003
358
vehicles within the scope of practice of EMT-D,
EMT-I, or EMT-P; EMT-I or EMT-P; and
(8) Keepingkeeping the care provided up to date
with current medical practice.
(b) Any tasks related to Paragraph (a) of this Rule may be
completed, through clearly established written delegation, by
assisting physicians, physician assistants, nurse practitioners,
registered nurses, EMD's, or EMT-P's.
(c) The medical directorMedical Director shall have the
authority to suspend temporarily, pending due process review,
any EMS personnel from further participation in the EMS
System when it is determined the activities or medical care
rendered by such personnel may be detrimental to the care of the
patient, constitute unprofessional behavior, or result in non-compliance
with credentialing requirements.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0405 REQUIREMENTS FOR
TREATMENT PROTOCOLS FOR EMS SYSTEMS
(a) Written Treatment Protocols:
(1) Used in EMS Systems shall meet the
minimum standard treatment protocols as
defined in the "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost;
(2) Used in Model EMS Systems shall also meet
the minimum standard treatment protocols for
Model EMS Systems as defined in the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the Office of
Emergency Medical Services,OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(3) Shall not contain medical procedures,
medications, or intravenous fluids that exceed
the scope of practice defined by the North
Carolina Medical Board pursuant to G.S. 143-
514 for the level of care offered in the EMS
System or any other applicable health care
licensing board.
(b) Treatment protocols developed locally shall, at a minimum,
meet the requirements of Paragraph (a) of this Rule, shall be
reviewed annually and any change in the treatment protocols
shall be submitted to the OEMS Medical Director for review and
approval at least 30 days prior to the implementation of the
change.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0406 REQUIREMENTS FOR
TREATMENT PROTOCOLS FOR SPECIALTY CARE
TRANSPORT PROGRAMS
(a) Treatment protocols used by medical crew members within a
Specialty Care Transport Program shall:
(1) be approved by the OEMS Medical Director
and incorporate all skills, medications,
equipment, and supplies for Specialty Care
Transport Programs as defined by the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the Office of
Emergency Medical Services,OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(2) not contain medical procedures, medications,
or intravenous fluids that exceed the scope of
practice of the medical crew members.
(b) Treatment protocols shall be reviewed annually, and any
change in the treatment protocols shall be submitted to the
OEMS Medical Director for review and approval at least 30
days prior to the implementation of the change.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0407 REQUIREMENTS FOR
EMERGENCY MEDICAL DISPATCH PRIORITY
REFERENCE SYSTEM
(a) EMDPRS used by EMD'san EMD within an approved EMD
program shall:
(1) be approved by the OEMS Medical Director
and meet or exceed the statewide standard for
EMDPRS as defined by the "North Carolina
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection,"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the Office of Emergency
Medical Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost; and
(2) not exceed the EMD scope of practice defined
by the North Carolina Medical Board pursuant
to G.S. 143-514.
(b) An EMDPRS developed locally shall be reviewed and
updated annually and submitted to the OEMS medical
directorMedical Director for approval. Any change in the
EMDPRS shall be submitted to the OEMS medical
directorMedical Director for review and approval at least 30
days prior to the implementation of the change.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0408 EMS PEER REVIEW
COMMITTEE FOR EMS SYSTEMS
(a) The quality management committeeEMS Peer Review
Committee for an EMS System shall:
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18:05 NORTH CAROLINA REGISTER September 2, 2003
359
(1) Bebe composed of at least one voting
representative from each of the following
components of the system:
(A) Physicians;physicians
(B) Nurses;nurses;
(C) Medicalmedical facility personnel
such as pharmacists or respiratory
therapists;
(D) EMS educators;
(E) Countycounty government officials;
and
(F) EMS providers.providers; and
(G) EMS personnel.
(2) Appointappoint a physician as chairperson;
(3) Meet,meet, at a minimum, on a quarterly basis;
(4) Ensure that a medical review committee as
referenced in G.S. 143-518(a)(5), or sub-committee
thereof, analyzesanalyze system
data to evaluate the ongoing quality of patient
care and medical direction within the system;
(5) Useuse information gained from system data
analysis to make recommendations regarding
the content of educationalcontinuing education
programs for EMS personnel;
(6) Reviewreview treatment protocols of the EMS
System and make recommendations to the
medical director for changes;
(7) Establishestablish a written procedure to
guarantee reviews for EMS personnel
temporarily suspended by the medical director;
and
(8) Maintain maintain minutes of committee
meetings throughout the approval period of the
EMS System.
(b) The quality management committeeEMS Peer Review
Committee shall adopt written guidelines that address at a
minimum:
(1) Structurestructure of committee membership;
(2) Appointmentappointment of committee
officers;
(3) Appointmentappointment of committee
members;
(4) Lengthlength of terms of committee members;
(5) Frequencyfrequency of attendance of
committee members;
(6) Establishmentestablishment of a quorum for
conducting business; and
(7) Confidentialityconfidentiality of medical
records and personnel issues.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0409 EMS PEER REVIEW
COMMITTEE FOR SPECIALTY CARE TRANSPORT
PROGRAMS
(a) The quality management committeeEMS Peer Review
Committee for a Specialty Care Transport Program shall:
(1) Bebe composed of membership as defined in
G.S. 131E-155(16a). The Committee shall
include at least one voting representative from
each of the following components of the
program:
(A) Physicians;physicians;
(B) Nurses;nurses;
(C) Medicalmedical facility personnel
such as pharmacists or respiratory
therapists;
(D) Educators;educators; and
(E) Medicalmedical crew members;
(2) Appointappoint a physician as chairperson;
(3) Meet,meet, at a minimum, on a quarterly basis;
(4) Ensure that a medical review committee as
referenced in G.S. 143-518(a)(5), or sub-committee
thereof, analyzes systemanalyze
program data to evaluate the ongoing quality
of patient care and medical direction within
the program;
(5) Useuse information gained from program data
analysis to make recommendations regarding
the content of educationalcontinuing education
programs for medical crew members;
(6) Reviewreview treatment protocols of the
Specialty Care Transport Programs and make
recommendations to the medical director for
changes;
(7) Establishestablish a written procedure to
guarantee reviews for medical crew members
temporarily suspended by the medical director;
and
(8) Maintain maintain minutes of committee
meetings throughout the approval period of the
Specialty Care Transport Program.
(b) Each quality management committeeEMS Peer Review
Committee shall adopt written guidelines that address at a
minimum:
(1) Structurestructure of committee membership;
(2) Appointmentappointment of committee
officers;
(3) Appointmentappointment of committee
members;
(4) Lengthlength of terms of committee members;
(5) Frequencyfrequency of attendance of
committee members;
(6) Establishmentestablishment of a quorum for
conducting business; and
(7) Confidentialityconfidentiality of medical
records and personnel issues.
Authority G.S. 143-508(b); 143-509(12).
SECTION .0500 – EMS PERSONNEL
10A NCAC 13P .0501 EDUCATIONAL PROGRAMS
(a) An educational program approved to qualify credentialed
EMS personnel to perform within their scope of practice shall be
offered by an EMS educational institution.
(b) Educational programs approved to qualify EMS personnel
for credentialing shall meet the educational objectives of the:
(1) "US DOT NHTSA First Responder: National
Standard Curriculum" for MR personnel;
(2) "US DOT NHTSA EMT-Basic: National
Standard Curriculum" for EMT personnel;
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18:05 NORTH CAROLINA REGISTER September 2, 2003
360
(3) "US DOT NHTSA EMT-Paramedic: National
Standard Curriculum" for EMT-I and EMT-P
personnel. For EMT-I personnel, the
educational objectives will be limited to the
following:
(A) Module 1: Preparatory
SECTION
TITLE LESSON
OBJECTIVES
1-1 EMS Systems / Roles & Responsibilities 1-1.1 – 1-1.46
1-2 The Well Being of the Paramedic 1-2.1 – 1-2.46
1-4 Medical / Legal Issues 1-4.1 – 1-4.35
1-5 Ethics 1-5.1 – 1-5.11
1-6
General Principles of Pathophysiology
1-6.3; 1-6.5 –1-6.9;
1-6.13 –1-6.16;
1-6.19 – 1-6.25;
1-6.27 – 1-6.31
1-7 Pharmacology 1-7.1 – 1-7.31
1-8
Venous Access / Medication Administration
1-8.1 – 1-8.8;
1-8.10 – 1-8.17;
1-8.19 – 1-8.34;
1-8.36 – 1-8.38;
1-8.40 – 1-8.43
1-9 Therapeutic Communications 1-9.1 – 1-9.21
(B) Module 2: Airway
SECTION TITLE LESSON
OBJECTIVES
2-1
Airway Management & Ventilation
2-1.1 – 2-1.10;
2-1.12 – 2-1.40;
2-1.42 – 2-1.64;
2-1.69;
2-1.73 – 2-1.89;
2-1.93 – 2-1.103;
2-1.104a-d;
2-1.105 – 2-1.106;
2-1.108
(4) "US DOT NHTSA Emergency Medical
Dispatcher: National Standard Curriculum" for
EMD personnel; or
(5) "National Guidelines for Educating EMS
Instructors" for EMS Instructors.
These documents are incoporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and
additions. These documents are available from NHTSA, 400 7th
Street, SW, Washington, D.C. 20590, at no cost.
(c) Educational programs approved to qualify EMS personnel
for renewal of credentials shall follow the guidelines of the:
(1) "US DOT NHTSA First Responder Refresher:
National Standard Curriculum" for MR
personnel;
(2) "US DOT NHTSA EMT-Basic Refresher:
National Standard Curriculum" for EMT
personnel;
(3) "EMT-P and EMT-I Continuing Education
National Guidelines" for EMT-I and EMT-P
personnel; or
(4) "US DOT NHTSA Emergency Medical
Dispatcher: National Standard Curriculum" for
EMD personnel.
These documents are incoporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and
additions. These documents are available from NHTSA, 400 7th
Street, SW, Washington, D.C. 20590, at no cost.
Authority G.S. 143-508(d)(3), (d)(4); 143-514.
10A NCAC 13P .0502 INITIAL CREDENTIALING
REQUIREMENTS FOR MR, EMT, EMT-I, EMT-P, AND
EMD
(a) MR, EMT, EMT-I, EMT-P, and EMD applicants shall meet
the following criteria within one year of the completion date of
the approved educational program for their level of application:
(1) Be at least 18 years of age;
(2) Successfully complete a scope of practice
performance evaluation, approved by the
OEMS, for the level of application.
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361
(A) For MR and EMT credentialing, this
evaluation shall be conducted under
the direction of a Level II EMS
Instructor credentialed at or above the
level of application; and
(B) For EMT-I, EMT-P, and EMD
credentialing, this evaluation shall be
conducted under the direction of the
educational medical advisor, a Level
II EMS Instructor credentialed at or
above the level of application and
designated by the educational medical
advisor; and
(3) Successfully complete a written examination
administered by the OEMS or equivalent.
Applicants who fail the written EMT
examination but achieve a minimum score of
70% on the medical responder subset
contained within the examination may be
credentialed as medical responders. If the
educational program was completed over one
year prior to application, applicants shall
submit evidence of completion of continuing
education during the past year. This
continuing education shall be consistent with
their level of application and approved by the
OEMS.
(b) EMD applicants shall successfully complete, within one
year prior to application, an AHA CPR course or equivalent,
including infant, child, and adult CPR, in addition to
Subparagraph (a)(1), (a)(2), and (a)(3) of this Rule.
Authority G.S. 131E-159 (a)(b); 143-508(d)(3).
10A NCAC 13P .0504 RENEWAL OF CREDENTIALS
FOR MR, EMT, EMT-I, EMT-P, AND EMD
MR, EMT, EMT-I, EMT-P and EMD applicants shall renew
credentials by presenting documentation to the OEMS that they
have successfully completed:
(1) an approved educational program as described
in Rule .0501(c) of this Subchapter; and
(2) within one year prior to renewal, a scope of
practice performance evaluation, approved by
the OEM S, for the level of application:
(a) for MR and EMT renewal, this
evaluation shall be conducted under
the direction of a Level II EMS
Instructor credentialed at or above the
level of application; and
(b) for EMT-I, EMT-P, and EMD
renewal, this evaluation shall be
conducted under the direction of the
educational medical advisor, a Level
II EMS Instructor credentialed at or
above the level of application and
designated by the educational medical
advisor.
Authority G.S. 131-159(a); 143-508(d)(3).
10A NCAC 13P .0506 PRACTICE SETTINGS FOR EMS
PERSONNEL
Credentialed EMS Personnel may function in the following
practice settings in accordance with the protocols approved by
the medical director of the EMS System or Specialty Care
Transport Program with which they are affiliated, and by the
OEMS:
(1) at the location of a physiological or
psychological illness or injury including
transportation to an appropriate treatment
facility if required;
(2) at public or community health facilities in
conjunction with public and community health
initiatives;
(3) in hospitals and clinics;
(4) in residences, facilities, or other locations as
part of wellness or injury prevention initiatives
within the commu nity and the public health
system; and
(5) at mass gatherings or special events.
Authority G.S. 143-508(d)(7).
10A NCAC 13P .0507 CREDENTIALING
REQUIREMENTS FOR LEVEL I EMS INSTRUCTORS
(a) Applicants for credentialing as a Level I EMS Instructor
shall:
(1) be currently credentialed by the OEMS as an
EMT, EMT-P, or EMD;
(2) have three years experience at the scope of
practice for the level of application;
(3) within one year prior to application,
successfully complete both a clinical and
educational scope of practice performance
evaluation, approved by the OEMS, for the
level of application:
(A) for a credential to teach at the EMT
level, this evaluation shall be
conducted under the direction of a
Level II EMS Instructor credentialed
at or above the level of application;
and
(B) for a credential to teach at the EMT-I
or EMT-P levels, this evaluation shall
be conducted under the direction of
the educational medical advisor, a
Level II EMS Instructor credentialed
at or above the level of application
and designated by the educational
medical advisor;
(C) for a credential to teach at the EMD
level, this evaluation shall be
conducted under the direction of the
educational medical advisor or a
Level I EMS Instructor credentialed
at the EMD level designated by the
educational medical advisor;
(4) have 100 hours of formal teaching experience
in an approved EMS educational program or
equivalent;
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18:05 NORTH CAROLINA REGISTER September 2, 2003
362
(5) successfully complete an educational program
as described in Rule .0501(b)(5) of this
Subchapter;
(6) within one year prior to application, attend a
Level I EMS Instructor workshop sponsored
by the OEMS; and
(7) have a high school diploma or General
Education Development certificate.
(b) The credential of a Level I EMS Instructor shall be valid for
four years, unless any of the following occurs:
(1) the OEMS imposes an administrative action
against the instructor credential; or
(2) the instructor fails to maintain a current EMT,
EMT-I, EMT-P, or EMD credential at the
highest level that the instructor is approved to
teach.
Authority G.S. 143-508(d)(3).
10A NCAC 13P .0508 CREDENTIALING
REQUIREMENTS FOR LEVEL II EMS INSTRUCTORS
(a) Applicants for credentialing as a Level II EMS Instructor
shall:
(1) be currently credentialed by the OEMS as an
EMT, EMT-I, or EMT-P;
(2) complete post-secondary level education equal
to or exceeding an Associate Degree;
(3) within one year prior to application,
successfully complete both a clinical and
educational scope of practice performance
evaluation, approved by the OEMS, for the
level of application:
(A) For a credential to teach at the EMT
level, this evaluation shall be
conducted under the direction of a
Level II EMS Instructor credentialed
at or above the level of application;
and
(B) For a credential to teach at the EMT-I
or EMT-P level, this evaluation shall
be conducted under the direction of
the educational medical advisor, a
Level II EMS Instructor credentialed
at or above the level of application
and designated by the educational
medical advisor;
(C) For a credential to teach at the EMD
level, this evaluation shall be
conducted under the direction of the
educational medical advisor or a
Level I EMS Instructor credentialed
at the EMD level designated by the
educational medical advisor;
(4) have two years teaching experience as a Level
I EMS Instructor or equivalent;
(5) successfully complete the "EMS Education
Administration Course" adopted by the North
Carolina Community College System,
incoporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and additions. This document is
available from the North Carolina Community
College System, 200 West Jones Street,
Raleigh, North Carolina 27603, at no cost; and
(6) attend a Level II EMS Instructor workshop
sponsored by the OEMS;
(b) The credential of a Level II EMS Instructor shall be valid for
four years, unless any of the following occurs:
(1) The OEMS imposes an administrative action
against the instructor credential; or
(2) The instructor fails to maintain a current EMT,
EMT-I, EMT-P, or EMD credential at the
highest level that the instructor is approved to
teach.
Authority G.S. 143-508(d)(3).
10A NCAC 13P .0509 CREDENTIALING OF
INDIVIDUALS TO ADMINISTER LIFESAVING
TREATMENT TO PERSONS SUFFERING AN ADVERSE
REACTION TO AGENTS THAT MIGHT CAUSE
ANAPHYLAXIS
(a) To become credentialed by the North Carolina Medical Care
Commission to administer epinephrine to persons who suffer
adverse reactions to agents that might cause anaphylaxis, a
person shall meet the following:
(1) Be 18 years of age or older; and
(2) Successfullysuccessfully complete an
educational program taught by a physician
licensed to practice medicine in North
Carolina or designee of the physician. The
educational program shall instruct individuals
in the appropriate use of procedures for the
administration of epinephrine to pediatric and
adult victims who suffer adverse reactions to
agents that might cause anaphylaxis and shall
include at a minimum the following:
(A) Definitiondefinition of anaphylaxis;
(B) Agents agents that might cause
anaphylaxis and the distinction
between them, including drugs,
insects, foods, and inhalants;
(C) Recognitionrecognition of symptoms
of anaphylaxis for both pediatric and
adult victims;
(D) Appropriateappropriate emergency
treatment of anaphylaxis as a result of
agents that might cause anaphylaxis;
(E) Availabilityavailability and design of
packages containing equipment for
administering epinephrine to victims
suffering from anaphylaxis as a result
of agents that might cause
anaphylaxis;
(F) Pharmacologypharmacology of
epinephrine including indications,
contraindications, and side effects;
(G) Discussiondiscussion of legal
implications of rendering aid; and
(H) Instructioninstruction that treatment
is to be utilized only in the absence of
the availability of physicians or other
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
363
practitioners who are authorized to
administer the treatment.
(b) A credential to administer epinephrine to persons who suffer
adverse reactions to agents that might cause anaphylaxis may be
issued by the North Carolina Medical Care Commission upon
receipt of a completed application signed by the applicant and
the physician who taught or was responsible for the educational
program. Applications may be obtained from the OEMS, 2707
Mail Service Center, Raleigh, North Carolina 27699-2707. All
credentials shall be valid for the period stated on the credential
issued to the applicant.
Authority G.S. 143-508(d)(11); 143-509(9).
10A NCAC 13P .0510 RENEWAL OF CREDENTIALS
FOR LEVEL I AND LEVEL II EMS INSTRUCTORS
(a) Level I and Level II EMS Instructor applicants shall renew
credentials by presenting documentation to the OEMS that they:
(1) are currently credentialed by the OEMS as an
EMT, EMT-I, or EMT-P, or EMD;
(2) successfully completed, within one year prior
to application, both a clinical and educational
scope of practice performance evaluation,
approved by the OEMS, for the level of
application:
(A) To renew a credential to teach at the
EMT level, this evaluation shall be
conducted under the direction of a
Level II EMS Instructor credentialed
at or above the level of application;
(B) To renew a credential to teach at the
EMT-I or EMT-P level, this
evaluation shall be conducted under
the direction of the educational
medical advisor, a Level II EMS
Instructor credentialed at or above the
level of application and designated by
the educational medical advisor; and
(C) To renew a credential to teach at the
EMD level, this evaluation shall be
conducted under the direction of the
educational medical advisor or a
Level I EMS Instructor credentialed
at the EMD level designated by the
educational medical advisor;
(3) completed 96 hours of EMS instruction at the
level of application; and
(4) completed 40 hours of educational
professional development.
(b) The credential of a Level I or Level II EMS Instructor shall
be valid for four years, unless any of the following occurs:
(1) the OEMS imposes an administrative action
against the instructor credential; or
(2) the instructor fails to maintain a current EMT,
EMT-I, EMT-P, or EMD credential at the
highest level that the instructor is approved to
teach.
Authority G.S. 131E-159(a)(b); 143-508(d)(3).
SECTION .0600 – EMS EDUCATIONAL INSTITUTIONS
10A NCAC 13P .0601 CONTINUING EDUCATION
EMS EDUCATIONAL INSTITUTION REQUIREMENTS
(a) Continuing Education EMS Educational Institutions shall be
credentialed by the OEMS to provide EMS continuing education
programs.
(b) Continuing Education EMS Educational Institutions shall
have, at a minimum:
(1) a Level I EMS Instructor as program
coordinator. The program coordinator shall
hold a Level I EMS Instructor credential at a
level equal to or greater than the highest level
of continuing education program offered in the
EMS System or Specialty Care Transport
Program;
(2) a continuing education program consistent
with the EMS System or Specialty Care
Transport Program continuing education plan
for EMS personnel;
(A) In an EMS System, the continuing
education programs for EMD, EMT-I,
and EMT-P shall be reviewed and
approved by the medical director of
the EMS System.
(B) In a Model EMS System, the
continuing education program shall
be reviewed and approved by the
system continuing education
coordinator and medical director.
(C) In a Specialty Care Transport
Program, the continuing education
program shall be reviewed and
approved by Specialty Care Transport
Program Continuing Education
Coordinator and the medical director.
(3) access to instructional supplies and equipment
necessary for students to complete educational
programs as defined in Rule .0501(c) of this
Subchapter;
(4) educational programs offered in accordance
with Rule .0501(c) of this Subchapter;
(5) an Educational Medical Advisor if offering
educational programs that have not been
reviewed and approved by a medical director
of an EMS System or Specialty Care Transport
Program. The Educational Medical Advisor
shall meet the criteria as defined in the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(6) a written educational plan describing the
delivery of educational programs, the record-keeping
system detailing student attendance
and performance, and the selection and
monitoring of EMS instructors.
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18:05 NORTH CAROLINA REGISTER September 2, 2003
364
(c) An application for credentialing as a Continuing Education
EMS Educational Institution shall be submitted to the OEMS for
review. The application shall demonstrate that the applicant
meets the requirements in Paragraph (b) of this Rule.
(d) Continuing Education EMS Educational Institution
credentials shall be valid for a period of four years.
(e) It is not necessary for Continuing Education EMS
Educational Institutions designated as the primary educational
delivery agency for a Model EMS System to submit an
application for renewal of credentials.
Authority G.S. 143-508(d)(4), (13).
10A NCAC 13P .0602 BASIC EMS EDUCATIONAL
INSTITUTION REQUIREMENTS
(a) Basic EMS Educational Institutions may offer MR, EMT,
and EMD courses for which they have been credentialed by the
OEMS.
(b) For initial courses, Basic EMS Educational Institutions shall
have, at a minimum:
(1) a Level I EMS Instructor as lead course
instructor for MR and EMT courses. The lead
course instructor must be credentialed at a
level equal to or higher than the course
offered;
(2) a Level I EMS Instructor credentialed at the
EMD level as lead course instructor for EMD
courses;
(3) a lead EMS educational program coordinator.
This individual may be either a Level II EMS
Instructor credentialed at or above the highest
level of course offered by the institution, or a
combination of staff who cumulatively meet
the requirements of the Level II EMS
Instructor referenced in this Paragraph. These
individuals may share the responsibilities of
the lead EMS educational coordinator. The
details of this option shall be defined in the
educational plan required in Paragraph (b)(5)
of this Rule. Basic EMS Educational
Institutions offering only EMD courses may
meet this requirement with a Level I EMS
Instructor credentialed at the EMD level;
(4) an Educational Medical Advisor that meets the
criteria as defined in the "North Carolina
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost;
(5) a written educational plan describing the
delivery of educational programs, the record-keeping
system detailing student attendance
and performance; and the selection and
monitoring of EMS instructors; and
(6) access to instructional supplies and equipment
necessary for students to complete educational
programs as defined in Rule .0501(c) of this
Subchapter.
(c) For EMS continuing education programs, Basic EMS
Educational Institutions shall meet the requirements defined in
Paragraphs (a) and (b) of Rule .0601 of this Section.
(d) An application for credentialing as a Basic EMS Educational
Institution shall be submitted to the OEMS for review. The
proposal shall demonstrate that the applicant meets the
requirements in Paragraphs (b) and (c) of this Rule.
(e) Basic EMS Educational Institution credentials shall be valid
for a period of four years.
(f) It is not necessary for Basic EMS Educational Institutions
designated as the primary educational delivery agency for a
Model EMS System to submit an application for renewal of
credentials.
Authority G.S. 143-508(d)(4), (13).
10A NCAC 13P .0603 ADVANCED EMS
EDUCATIONAL INSTITUTION REQUIREMENTS
(a) Advanced EMS Educational Institutions may offer all EMS
educational programs for which they have been credentialed by
the OEMS.
(b) For initial courses, Advanced EMS Educational Institutions
shall have, at a minimum:
(1) a Level I EMS Instructor as lead course
instructor for MR and EMT courses. The lead
course instructor must be credentialed at a
level equal to or higher than the course
offered;
(2) a Level I EMS Instructor credentialed at the
EMD level as lead course instructor for EMD
courses;
(3) a Level II EMS Instructor as lead instructor for
EMT-I and EMT-P courses. The lead course
instructor must be credentialed at a level equal
to or higher than the course offered;
(4) a lead EMS educational program coordinator.
This individual may be either a Level II EMS
Instructor credentialed at or above the highest
level of course offered by the institution, or a
combination of staff who cumulatively meet
the requirements of the Level II EMS
Instructor referenced in this paragraph. These
individuals may share the responsibilities of
the lead EMS educational coordinator. The
details of this option shall be defined in the
educational plan required in Paragraph (b)(6)
of this Rule;
(5) an Educational Medical Advisor that meets the
criteria as defined in the "North Carolina
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection,"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost;
(6) a written educational plan describing the
delivery of educational programs, the record-
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
365
keeping system detailing student attendance
and performance; and the selection and
monitoring of EMS instructors; and
(7) access to instructional supplies and equipment
necessary for students to complete educational
programs as defined in Rule .0501(c) of this
Subchapter.
(c) For EMS continuing education programs, Advanced EMS
Educational Institutions shall meet the requirements defined in
Paragraphs (a) and (b) of Rule .0601 of this Section.
(d) An application for credentialing as an Advanced EMS
Educational Institution shall be submitted to the OEMS for
review. The application shall demonstrate that the applicant
meets the requirements in Paragraphs (b) and (c) of this Rule.
Advanced EMS Educational Institutions holding current
accreditation by a national EMS educational accreditation
agency that has been recognized by OEMS may use this
accreditation as documentation toward meeting the requirements
of Paragraphs (b) and (c) of this Rule.
(e) Advanced Educational Institution credentials shall be valid
for a period of four years.
(f) It is not necessary for Advanced EMS Educational
Institutions designated as the primary educational delivery
agency for a Model EMS System to submit an application for
renewal of credentials.
Authority G.S. 143-508(d)(4), (13).
10A NCAC 13P .0604 TRANSITION FOR APPROVED
TEACHING INSTITUTIONS
Approved Teaching Institutions under contract with the OEMS
as of April 30, 2002, shall be credentialed as an EMS
Educational Institution consistent with the existing level of
approval through December 31, 2003. These institutions may
continue to offer courses currently allowed under the contract
while preparing for credentialing under Ru les .0601, .0602, and
.0603.
Authority G.S. 143-508(b).
SECTION .0700 – ENFORCEMENT
10A NCAC 13P .0701 DENIAL, SUSPENSION,
AMENDMENT OR REVOCATION
(a) The Department may deny, suspend, or revoke the permit of
an ambulance or EMS nontransporting vehicle if the EMS
provider:
(1) fails to substantially comply with the
requirements of Section .0200 of this
Subchapter;
(2) obtains or attempts to obtain a permit through
fraud or misrepresentation; or
(3) fails to provide emergency medical care within
the defined EMS service area in a timely
manner.
(b) In lieu of suspension or revocation, the Department may
issue a temporary permit for an ambulance or EMS
nontransporting vehicle whenever the Department finds that:
(1) the EMS provider to which that vehicle is
assigned has substantially failed to comply
with the provisions of G.S. 131E, Article 7,
and the rules adopted under that article; or
(2) there is a reasonable probability that the EMS
provider can remedy the permit deficiencies
within a length of time determined by the
department; or
(3) there is a reasonable probability that the EMS
provider will be willing and able to remain in
compliance with the rules regarding vehicle
permits for the foreseeable future.
(c) The Department shall give the EMS provider written notice
of the temporary permit. This notice shall be given personally or
by certified mail and shall set forth:
(1) the duration of the temporary permit not to
exceed 60 days;
(2) a copy of the vehicle inspection form;
(3) the statutes or rules alleged to be violated; and
(4) notice to the EMS provider's right to a
contested case hearing on the temporary
permit.
(d) The temporary permit shall be effective immediately upon
its receipt by the EMS provider and shall remain in effect until
the earlier of the expiration date of the permit or until the
Department:
(1) restores the vehicle to full permitted status; or
(2) suspends or revokes the vehicle permit.
(e) The Department may deny, suspend, or revoke the
credentials of EMS personnel for any of the following reasons:
(1) failure to comply with the applicable
performance and credentialing requirements as
found in this Subchapter;
(2) making false statements or representations to
the OEMS or willfully concealing information
in connection with an application for
credentials;
(3) being unable to perform as credentialed EMS
personnel with reasonable skill and safety to
patients and the public by reason of illness, use
of alcohol, drugs, chemicals, or any other type
of material or by reason of any physical or
mental abnormality;
(4) unprofessional conduct, including but not
limited to a failure to comply with the rules
relating to the proper function of credentialed
EMS personnel contained in this Subchapter or
the performance of or attempt to perform a
procedure that is detrimental to the health and
safety of any person or that is beyond the
scope of practice of credentialed EMS
personnel or EMS instructors;
(5) conviction in any court of a crime involving
moral turpitude, a conviction of a felony, or
conviction of a crime involving the scope of
practice of credentialed EMS personnel;
(6) by false representations obtaining or
attempting to obtain money or anything of
value from a patient;
(7) adjudication of mental incompetence;
(8) lack of competence to practice with a
reasonable degree of skill and safety for
patients including but not limited to a failure to
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366
perform a prescribed procedure, failure to
perform a prescribed procedure competently or
performance of a procedure that is not within
the scope of practice of credentialed EMS
personnel or EMS instructors;
(9) making false statements or representations,
willfully concealing information, or failing to
respond within a reasonable period of time and
in a reasonable manner to inquiries from the
OEMS;
(10) testing positive for any substance, legal or
illegal, that is likely to impair the physical or
psychological ability of the credentialed EMS
personnel to perform all required or expected
functions while on duty;
(11) representing or allowing others to represent
that the credentialed EMS personnel has a
credential that the credentialed EMS personnel
does not in fact have; or
(12) failure to comply with G.S. 143-518 regarding
the use or disclosure of records or data
associated with EMS Systems, Specialty Care
Transport Programs, or patients.
(f) The Department may amend any EMS provider license by
reducing it from a full license to a provisional license whenever
the Department finds that:
(1) the licensee has substantially failed to comply
with the provisions of G.S. 131E, Article 7,
and the rules adopted under that article;
(2) there is a reasonable probability that the
licensee can remedy the licensure deficiencies
within a reasonable length of time; and
(3) there is a reasonable probability that the
licensee will be able thereafter to remain in
compliance with the licensure rules for the
foreseeable future.
(g) The Department shall give the licensee written notice of the
amendment to the EMS provider license. This notice shall be
given personally or by certified mail and shall set forth:
(1) the length of the provisional EMS provider
license;
(2) the factual allegations;
(3) the statutes or rules alleged to be violated; and
(4) notice to the EMS provider's right to a
contested case hearing on the amendment of
the EMS provider license.
(h) The provisional EMS provider license shall be effective
immediately upon its receipt by the licensee and shall be posted
in a prominent location at the primary business location of the
EMS provider, accessible to public view, in lieu of the full
license. The provisional license shall remain in effect until the
Department:
(1) restores the licensee to full licensure status; or
(2) revokes the licensee’s license.
(i) The Department may revoke or suspend an EMS provider
license whenever the Department finds that the licensee:
(1) has substantially failed to comply with the
provisions of G.S. 131E, Article 7, and the
rules adopted under that article and it is not
reasonably probable that the licensee can
remedy the licensure deficiencies within a
reasonable length of time;
(2) has substantially failed to comply with the
provisions of G.S. 131E, Article 7, and the
rules adopted under that article and, although
the licensee may be able to remedy the
deficiencies within a reasonable period of
time, it is not reasonably probable that the
licensee will be able to remain in compliance
with licensure rules for the foreseeable future;
(3) has failed to comply with the provision of G.S.
131E, Article 7, and the rules adopted under
that article that endanger the health, safety or
welfare of the patients cared for or transported
by the licensee; or
(4) obtained or attempted to obtain an ambulance
permit, EMS nontransporting vehicle permit,
or EMS provider license through fraud or
misrepresentation.
(j) The issuance of a provisional EMS provider license is not a
procedural prerequisite to the revocation or suspension of a
license pursuant to Paragraph (i) of this Rule.
(k) The Department may amend, deny, suspend, or revoke the
credential of an EMS educational institution for any of the
following reasons:
(1) failure to substantially comply with the
requirements of Section .0600 of this
Subchapter; or
(2) obtaining or attempting to obtain a credential
through fraud or misrepresentation.
(l) The Department may amend, deny, suspend, or revoke the
approval of an EMS System or designation of a Model EMS
System for any of the following reasons:
(1) failure to substantially comply with the
requirements of Section .0200 of this
Subchapter; or
(2) obtaining or attempting to obtain designation
through fraud or misrepresentation.
(m) The Department may amend, deny, suspend, or revoke the
designation of a Specialty Care Transport Program for any of the
following reasons:
(1) failure to substantially comply with the
requirements of Section .0300 of this
Subchapter; or
(2) obtaining or attempting to obtain designation
through fraud or misrepresentation.
Authority G.S. 131E-155.1(d); 131E-157(c); 131E-159(a);
143-508(d)(10).
SECTION .0900 – TRAUMA CENTER STANDARDS AND
APPROVAL
10A NCAC 13P .0901 LEVEL I TRAUMA CENTER
CRITERIA
To receive designation as a Level I Trauma Center, a hospital
shall have the following:
(1) A trauma program and a trauma service that
have been operational for at least six months
prior to application for designation;
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
367
(2) Membership in and inclusion of all trauma
patient records in the North Carolina Trauma
Registry for at least six months prior to
submitting a Request for Proposal;
(3) Trauma medical director who is a board-certified
general surgeon. The trauma medical
director must:
(a) Have a minimum of three years
clinical experience on a trauma
service or trauma fellowship training;
(b) Serve on the center's trauma service;
(c) Participate in providing care to
patients with life -threatening or
urgent injuries;
(d) Participate in the North Carolina
Chapter of the ACS Committee on
Trauma as well as other regional and
national trauma organizations;
(e) Remain a current provider in the
ACS' Advanced Trauma Life Support
Course and in the provision of
trauma-related instruction to other
health care personnel; and
(f) Be involved with trauma research and
the publication of results and
presentations.
(4) A full-time trauma nurse coordinator
(TNC)/program manager (TPM) who is a
registered nurse, licensed by the North
Carolina Board of Nursing;
(5) A full-time trauma registrar (TR) who has a
working knowledge of medical terminology, is
able to operate a personal computer, and has
demonstrated the ability to extract data from
the medical record;
(6) A hospital department/division/section for
general surgery, neurological surgery,
emergency medicine, anesthesiology, and
orthopaedic surgery, with designated chair or
physician liaison to the trauma program for
each;
(7) Clinical capabilities in general surgery with
two separate posted call schedules. One shall
be for trauma, one for general surgery. In
those instances where a physician may
simultaneously be listed on both schedules,
there must be a defined back-up surgeon listed
on the schedule to allow the trauma surgeon to
provide care for the trauma patient. The
trauma service director shall specify, in
writing, the specific credentials that each back-up
surgeon must have. These, at a minimum,
must state that the back-up surgeon has
surgical privileges at the trauma center and is
boarded or eligible in general surgery (with
board certification in general surgery within
five years of completing residency). If a
trauma surgeon is simultaneously on call at
more than one hospital, there shall be a
defined, posted trauma surgery back-up call
schedule composed of surgeons credentialed to
serve on the trauma panel.
(8) Response of a trauma team to provide
evaluation and treatment of a trauma patient
24 hours per day that includes:
(a) An in-house Post Graduate Year 4
(PGY4) or senior general surgical
resident, at a minimum, who is a
member of that hospital's surgical
residency program and responds
within 20 minutes of notification;
(b) A trauma attending whose presence at
the patient's bedside within 20
minutes of notification is documented
and who participates in therapeutic
decisions and is present at all
operative procedures;
(c) An emergency physician who is
present in the Emergency Department
24 hours per day who is either board-certified
or prepared in emergency
medicine (by the American Board of
Emergency Medicine or the
American Osteopathic Board of
Emergency Medicine). Emergency
physicians caring only for pediatric
patients may, as an alternative, be
boarded or prepared in pediatric
emergency medicine. Emergency
physicians must be board-certified
within five years after successful
completion of a residency in
emergency medicine and serve as a
designated member of the trauma
team until the arrival of the trauma
surgeon;
(d) Neurosurgery specialists who are
never simultaneously on-call at
another Level II or higher trauma
center, who are promptly available, if
requested by the trauma team leader,
unless there is either an in-house
attending neurosurgeon, a Post
Graduate Year 2 (PGY2) or higher in-house
neurosurgery resident or an in-house
trauma surgeon or emergency
physician as long as the institution
can document management
guidelines and annual continuing
medical education for neurosurgical
emergencies. There must be a
specified written back-up on the call
schedule whenever the neurosurgeon
is simultaneously on-call at a hospital
other than the trauma center;
(e) Orthopaedic surgery specialists who
are never simultaneously on-call at
another Level II or higher trauma
center, who are promptly available, if
requested by the trauma team leader,
unless there is either an in-house
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
368
attending orthopaedic surgeon, a Post
Graduate Year 2 (PGY2) or higher in-house
orthopaedic surgery resident or
an in-house trauma surgeon or
emergency physician as long as the
institution can document management
guidelines and annual continuing
medical education for orthopaedic
emergencies. There must be a
specified written back-up on the call
schedule whenever the orthopaedist is
simultaneously on-call at a hospital
other than the trauma center;
(f) An in-house anesthesiologist or a
Clinical Anesthesiology Year 3
(CA3) resident as long as an
anesthesiologist on-call is advised
and promptly available if requested
by the trauma team leader, and
(g) Registered nursing personnel trained
in the care of trauma patients.
(9) A written credentialing process established by
the Department of Surgery to approve mid-level
practitione

NORTH CAROLINA
REGISTER
Volume 18, Issue 5
Pages 344 - 416
September 2, 2003
This issue contains documents officially filed
through August 11, 2003.
Office of Administrative Hearings
Rules Division
424 North Blount Street (27601)
6714 Mail Service Center
Raleigh, NC 27699-6714
(919) 733-2678
FAX (919) 733-3462
Julian Mann III, Director
Camille Winston, Deputy Director
Molly Masich, Director of APA Services
Ruby Creech, Publications Coordinator
Linda Dupree, Editorial Assistant
Dana Sholes, Editorial Assistant
Rhonda Wright, Editorial Assistant
IN THIS ISSUE
I. PROPOSED RULES
Administration
State Building Commission......................................344 - 347
Environment and Natural Resources
Health Services, Commission for............................385 - 388
Health and Human Services
Medical Care Commission........................................347 - 385
Licensing Boards
Nursing, Board of.......................................................394 - 399
Transportation
Highways, Division of...............................................388 - 394
II. TEMPORARY RULES
Administrative Hearings, Office of
Rules Division – Expired Temporary Rules ..........400
III. RULES REVIEW COMMISSION..........................401
IV. CONTESTED CASE DECISIONS
Index to ALJ Decisions.................................................402 - 404
Text of Selected Decisions
02 INS 1257.................................................................405 - 409
02 OSP 1001................................................................410 - 416
For the CUMULATIVE INDEX to the NC Register go to:
http://oahnt.oah.state.nc.us/register/CI.pdf
North Carolina Register is published semi-monthly for $195 per year by the Office of Administrative Hearings, 424 North Blount Street, Raleigh, NC
27601. North Carolina Register (ISSN 15200604) to mail at Periodicals Rates is paid at Raleigh, NC. POSTMASTER: Send Address changes to
the North Carolina Register, 6714 Mail Service Center, Raleigh, NC 27699-6714.
NORTH CAROLINA ADMINISTRATIVE CODE CLASSIFICATION SYSTEM
The North Carolina Administrative Code (NCAC) has four major subdivisions of rules. Two of these, titles and
chapters, are mandatory. The major subdivision of the NCAC is the title. Each major department in the North
Carolina executive branch of government has been assigned a title number. Titles are further broken down into
chapters which shall be numerical in order. The other two, subchapters and sections are optional subdivisions to
be used by agencies when appropriate.
TITLE/MAJOR DIVISIONS OF THE NORTH CAROLINA ADMINISTRATIVE CODE
TITLE DEPARTMENT LICENSING BOARDS CHAPTER
1
2
3
4
5
6
7
8
9
10
11
12
13
14A
15A
16
17
18
19A
20
*21
22
23
24
25
26
27
28
Administration
Agriculture
Auditor
Commerce
Correction
Council of State
Cultural Resources
Elections
Governor
Health and Human Services
Insurance
Justice
Labor
Crime Control & Public Safety
Environment and Natural Resources
Public Education
Revenue
Secretary of State
Transportation
Treasurer
Occupational Licensing Boards
Administrative Procedures (Repealed)
Community Colleges
Independent Agencies
State Personnel
Administrative Hearings
NC State Bar
Juvenile Justice and Delinquency
Prevention
Acupuncture
Architecture
Athletic Trainer Examiners
Auctioneers
Barber Examiners
Certified Public Accountant Examiners
Chiropractic Examiners
Employee Assistance Professionals
General Contractors
Cosmetic Art Examiners
Dental Examiners
Dietetics/Nutrition
Electrical Contractors
Electrolysis
Foresters
Geologists
Hearing Aid Dealers and Fitters
Landscape Architects
Landscape Contractors
Locksmith Licensing Board
Massage & Bodywork Therapy
Marital and Family Therapy
Medical Examiners
Midwifery Joint Committee
Mortuary Science
Nursing
Nursing Home Administrators
Occupational Therapists
Opticians
Optometry
Osteopathic Examination & Reg. (Repealed)
Pastoral Counselors, Fee-Based Practicing
Pharmacy
Physical Therapy Examiners
Plumbing, Heating & Fire Sprinkler Contractors
Podiatry Examiners
Professional Counselors
Psychology Board
Professional Engineers & Land Surveyors
Real Estate Appraisal Board
Real Estate Commission
Refrigeration Examiners
Respiratory Care Board
Sanitarian Examiners
Social Work Certification
Soil Scientists
Speech & Language Pathologists & Audiologists
Substance Abuse Professionals
Therapeutic Recreation Certification
Veterinary Medical Board
1
2
3
4
6
8
10
11
12
14
16
17
18
19
20
21
22
26
28
29
30
31
32
33
34
36
37
38
40
42
44
45
46
48
50
52
53
54
56
57
58
60
61
62
63
69
64
68
65
66
Note: Title 21 contains the chapters of the various occupational licensing boards.
NORTH CAROLINA REGISTER
Publication Schedule for July 2003 – December 2003
FILING DEADLINES NOTICE OF TEXT PERMANENT RULE TEMPORARY
RULES
Volume &
issue
number
Issue date Last day
for filing
Earliest date for
public hearing
End of required
comment
period
Deadline to submit
to RRC
for review at
next meeting
Earliest Eff.
Date of
Permanent Rule
Delayed Eff. Date of
Permanent Rule
(first legislative
day of the next
regular session)
270th day from publication
in the Register
17:13 01/02/03 12/06/02 01/17/03 03/03/03 03/20/03 05/01/03 05/10/04 09/29/03
17:14 01/15/03 12/19/02 01/30/03 03/17/03 03/20/03 05/01/03 05/10/04 10/12/03
17:15 02/03/03 01/10/03 02/18/03 04/04/03 04/21/03 06/01/03 05/10/04 10/31/03
17:16 02/17/03 01/27/03 03/04/03 04/21/03 04/21/03 06/01/03 05/10/04 11/14/03
17:17 03/03/03 02/10/03 03/18/03 05/02/03 05/20/03 07/01/03 05/10/04 11/28/03
17:18 03/17/03 02/24/03 04/01/03 05/16/03 05/20/03 07/01/03 05/10/04 12/12/03
17:19 04/01/03 03/11/03 04/16/03 06/02/03 06/20/03 08/01/03 05/10/04 12/27/03
17:20 04/15/03 03/25/03 04/30/03 06/16/03 06/20/03 08/01/03 05/10/04 01/10/04
17:21 05/01/03 04/09/03 05/16/03 06/30/03 07/21/03 09/01/03 05/10/04 01/26/04
17:22 05/15/03 04/24/03 05/30/03 07/14/03 07/21/03 09/01/03 05/10/04 02/09/04
17:23 06/02/03 05/09/03 06/17/03 08/01/03 08/20/03 10/01/03 05/10/04 02/27/04
17:24 06/16/03 05/23/03 07/01/03 08/15/03 08/20/03 10/01/03 05/10/04 03/12/04
18:01 07/01/03 06/10/03 07/16/03 09/02/03 09/22/03 11/01/03 05/10/04 03/27/04
18:02 07/15/03 06/23/03 07/30/03 09/15/03 09/22/03 11/01/03 05/10/04 04/10/04
18:03 08/01/03 07/11/03 08/16/03 09/30/03 10/20/03 12/01/03 05/10/04 04/27/04
18:04 08/15/03 07/25/03 08/30/03 10/14/03 10/20/03 12/01/03 05/10/04 05/11/04
18:05 09/02/03 08/11/03 09/17/03 11/03/03 11/20/03 01/01/04 05/10/04 05/29/04
18:06 09/15/03 08/22/03 09/30/03 11/14/03 11/20/03 01/01/04 05/10/04 06/11/04
18:07 10/01/03 09/10/03 10/16/03 12/01/03 12/22/03 02/01/04 05/10/04 06/27/04
18:08 10/15/03 09/24/03 10/30/03 12/15/03 12/22/03 02/01/04 05/10/04 07/11/04
18:09 11/03/03 10/13/03 11/18/03 01/02/04 01/20/04 03/01/04 05/10/04 07/30/04
18:10 11/17/03 10/24/03 12/02/03 01/16/04 01/20/04 03/01/04 05/10/04 08/13/04
18:11 12/01/03 11/05/03 12/16/03 01/30/04 02/20/04 04/01/04 05/10/04 08/27/04
18:12 12/15/03 11/20/03 12/30/03 02/13/04 02/20/04 04/01/04 05/10/04 09/10/04
EXPLANATION OF THE PUBLICATION SCHEDULE
This Publication Schedule is prepared by the Office of Administrative Hearings as a public service and the computation of time periods are not to be deemed binding or controlling.
Time is computed according to 26 NCAC 2C .0302 and the Rules of Civil Procedure, Rule 6.
GENERAL
The North Carolina Register shall be published twice
a month and contains the following information
submitted for publication by a state agency:
(1) temporary rules;
(2) notices of rule-making proceedings;
(3) text of proposed rules;
(4) text of permanent rules approved by the Rules
Review Commission;
(5) notices of receipt of a petition for municipal
incorporation, as required by G.S. 120-165;
(6) Executive Orders of the Governor;
(7) final decision letters from the U.S. Attorney
General concerning changes in laws affecting
voting in a jurisdiction subject of Section 5 of
the Voting Rights Act of 1965, as required by
G.S. 120-30.9H;
(8) orders of the Tax Review Board issued under
G.S. 105-241.2; and
(9) other information the Codifier of Rules
determines to be helpful to the public.
COMPUTING TIME: In computing time in the
schedule, the day of publication of the North Carolina
Register is not included. The last day of the period so
computed is included, unless it is a Saturday, Sunday,
or State holiday, in which event the period runs until
the preceding day which is not a Saturday, Sunday, or
State holiday.
FILING DEADLINES
ISSUE DATE: The Register is published on the first
and fifteen of each month if the first or fifteenth of
the month is not a Saturday, Sunday, or State holiday
for employees mandated by the State Personnel
Commission. If the first or fifteenth of any month is
a Saturday, Sunday, or a holiday for State employees,
the North Carolina Register issue for that day will be
published on the day of that month after the first or
fifteenth that is not a Saturday, Sunday, or holiday for
State employees.
LAST DAY FOR FILING: The last day for filing
for any issue is 15 days before the issue date
excluding Saturdays, Sundays, and holidays for State
employees.
NOTICE OF TEXT
EARLIEST DATE FOR PUBLIC HEARING: The
hearing date shall be at least 15 days after the date a
notice of the hearing is published.
END OF REQUIRED COMMENT PERIOD
(1) RULE WITH NON-SUBSTANTIAL
ECONOMIC IMPACT: An agency shall accept
comments on the text of a proposed rule for at least
60 days after the text is published or until the date of
any public hearings held on the proposed rule,
whichever is longer.
(2) RULE WITH SUBSTANTIAL ECONOMIC
IMPACT: An agency shall accept comments on the
text of a proposed rule published in the Register and
that has a substantial economic impact requiring a
fiscal note under G.S. 150B-21.4(b1) for at least 60
days after publication or until the date of any public
hearing held on the rule, whichever is longer.
DEADLINE TO SUBMIT TO THE RULES
REVIEW COMMISSION: The Commission shall
review a rule submitted to it on or before the
twentieth of a month by the last day of the next
month.
FIRST LEGISLATIVE DAY OF THE NEXT
REGULAR SESSION OF THE GENERAL
ASSEMBLY: This date is the first legislative day of
the next regular session of the General Assembly
following approval of the rule by the Rules Review
Commission. See G.S. 150B-21.3, Effective date of
rules.
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
344
This Section contains the text of proposed rules. The agency must accept comments on the proposed rule for at least 60 days
from the publication date, or until the public hearing, or a later date if specified in the notice by the agency. Statutory reference:
G.S. 150B-21.
TITLE 01 – DEPARTMENT OF ADMINISTRATION
Notice is hereby given in accordance with G.S. 150B-21.2 that
the State Building Commission intends to adopt the rules cites as
01 NCAC 30A .0406; 30J .0101-.0103, .0201-.0202, .0301-
.0306.
Proposed Effective Date: January 1, 2004
Public Hearing:
Date: September 30, 2003
Time: 2:00 p.m. – 4:00 p.m.
Location: State Construction Office, Conference Room, Suite
450, New Education Building, 301 N. Wilmington St., Raleigh,
NC
Reason for Proposed Action:
01 NCAC 30A .0406 – S.L. 2001-496, Sec. 11(1) (SB914)
requires the State Building Commission to adopt rules governing
review and final approval of plans submitted to the State
Construction Office pursuant to G.S. 58-31-40. Temporary rules
were adopted in February of 2003.
01 NCAC 30J .0101-.0103, .0201-.0202, .0301-.0306 – S.L.
2001-496, Sec. 11(1) (SB914) requires the State Building
Commission to adopt rules to ensure that designers, consultants
and construction managers at risk selected for State Capital
improvement projects have the necessary qualifications and
experience to complete those projects . Temporary rules were
adopted in February of 2003.
Comment Procedures: Comments from the public shall be
directed to Speros Fleggas, Director, State Construction Office,
1307 Mail Service Center, Raleigh, NC 27699-1309, phone
(919) 733-7962 and email speros.fleggas@ncmail.net.
Comment period ends November 3, 2003.
Procedure for Subjecting a Proposed Rule to Legislative
Review: Any person who objects to the adoption of a permanent
rule may submit written comments to the agency. A person may
also submit written objections to the Rules Review Commission.
If the Rules Review Commission receives written and signed
objections in accordance with G.S. 150B-21.3(b2) from 10 or
more persons clearly requesting review by the legislature and the
Rules Review Commission approves the rule, the rule will
become effective as provided in G.S. 150B-21.3(b1). The
Commission will receive written objections until 5:00 p.m. on
the 6th business day preceding the end of the month in which a
rule is approved. The Commission will receive those objections
by mail, delivery service, hand delivery, or facsimile
transmission. If you have any further questions concerning the
submission of objections to the Commission, please call a
Commission staff attorney at 919-733-2721.
Fiscal Impact
State
Local
Substantive (>$3,000,000)
None
CHAPTER 30 - STATE CONSTRUCTION
SUBCHAPTER 30A - DIVISION OF STATE
CONSTRUCTION
SECTION .0400 - CONSTRUCTION ADMINISTRATION
OFFICE
01 NCAC 30A .0406 REVIEW BY STATE
CONSTRUCTION OFFICE FOR FIRE SAFETY
REQUIREMENTS
In all cases where plans are submitted to the State Construction
Office pursuant to G.S. 58-31-40:
(1) The owner shall submit complete construction
documents to the State Construction Office in
accordance with the planning procedures in the
State Construction Manual.
(2) Pursuant to G.S. 58-31-40 (c), should an
owner request review and final approval of the
plans by the State Construction Office and the
Department of Insurance and if the plans have
not been approved by the Commissioner of
Insurance within 60 days of submittal, such
review and final approval shall be conducted
by the State Construction Office within 30
days.
(3) No type of structural work may be initiated by
the owner without prior approval of the State
Construction Office.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
SUBCHAPTER 30J - CONSTRUCTION MANAGER-AT-RISK
SELECTION PROCEDURES
SECTION .0100 – GENERAL PROVISIONS
01 NCAC 30J .0101 AUTHORITY
The State Building Commission, hereinafter referred to as SBC,
is a statutory body, empowered by public law (G.S. 143-135.26)
to perform a multiplicity of duties with regard to the State's
capital facilit ies development and management program. In the
specific area of State capital improvement project construction
manager-at-risk selection, the SBC is empowered to adopt rules
establishing standard procedures and criteria to assure that the
construction manager-at-risk selected for each State capital
improvement project has the qualifications and experience
necessary for that capital improvement project. The SBC is
responsible and accountable for the final selection of the
construction manager-at-risk. The exceptions are the University
of North Carolina and the General Assembly, which shall be
responsible and accountable for the final selection of
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
345
construction manger-at-risk for capital projects in which they are
the funded agencies.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0102 POLICY
It is the policy of the SBC to select construction manager-at-risk
for State capital improvement projects as defined in G.S. 143-
128.1, based on criteria contained herein and to make available
to every firm, duly licensed as a general contractor in the State
of North Carolina, the opportunity to be considered for
providing construction management-at-risk services for those
departments and agencies under its jurisdiction. It is also the
policy of the SBC to select a construction manager-at-risk for
State capital improvement project who is in compliance with the
minority business participation requirements as prescribed in
G.S. 143-128.2. The SBC considers that the selection of
competent construction manager-at-risk is vital to providing the
State of North Carolina with the best and most appropriate
facilities consistent with authorized funds. These procedures are
intended to provide a basis for the fair and uniform selection of
construction managers-at-risk. The construction manager-at-risk
shall use standard form of contract for the owner, construction
manager-at-risk, and first-tier subcontractor authorized by the
SBC.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0103 DEFINITIONS
For purposes of this Subchapter, the following definitions shall
apply:
(1) "Capital Projects Coordinator" means the
individual authorized by each funded agency
to coordinate all capital improvement projects
and related matters with the State Construction
Office and to represent that agency on all
matters presented to the SBC. The individual
so designated for purposes of these Rules may
have other titles within his agency but shall
carry out the duties assigned herein to the
capital projects coordinator. Whenever the
capital projects coordinator is referenced
herein, it shall be understood to include a
designated assistant or representative.
(2) "Construction Manager-at-Risk" means a
person, corporation, or entity that provides
construction management at risk services.
(3) "Construction Management-at-Risk Services"
means services provided by a person,
corporation, or entity that
(a) provides construction management
services for a project throughout the
preconstruction and construction
phases;
(b) who is licensed as a general
contractor; and
(c) who guarantees the cost of the
project.
(4) "First-Tier Subcontractor" means a
subcontractor who contracts directly with the
Construction Manager-at-Risk.
(5) "Contact person" means the person named in
the public advertisement who shall be the
Capital Projects Coordinator or his/her
designee.
(6) "Funded agency" means the department,
agency, authority or office that is named in the
legislation appropriating funds for the design
and/or construction project.
(7) "Using agency" means the subdivision of the
funded agency for whose use the project is to
be provided. If the funded agency is so
subdivided for administrative control, the
using agency would be a division,
geographically self-contained facility, campus
or similar body, as determined by the
administrative head of the funded agency.
(8) "Minority Business" means:
(a) in which at least 51 percent is owned
by one or more minority persons, or
in the case of corporation, in which at
least 51 percent of the stock is owned
by one or more minority persons or
socially and economically
disadvantaged individuals; and
(b) of which the management and daily
business operations are controlled by
one or more of the minority persons
or socially and economically
disadvantaged individuals who own
it.
(9) "Socially and economically disadvantaged
individual" means the same as defined in 15
U.S.C. 637.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
SECTION .0200 - PROJECT INFORMATION
01 NCAC 30J .0201 PROJECT DESCRIPTION
It shall be the responsibility of each Capital Projects Coordinator
to provide the State Construction Office with a written
description of the construction management-at-risk services
desired, the program or scope of work, schedule requirements,
amount of authorized funds and other appropriate information
for each project requiring construction management-at-risk
services. This information should be provided to the State
Construction Office for publication on State Construction Office
website. The Capital Projects Coordinator is responsible for
prompt initiation of the Construction Manager-at-Risk selection
process and shall make his/her best effort to enable the
completion of the selection process within 60 days of the date of
the above notification.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0202 PUBLIC ANNOUNCEMENT
Based upon project information furnished by a Capital Projects
Coordinator, the State Construction Office shall publish an
announcement of the need for construction management-at-risk
services, a designated contact person in the using agency and the
closing date on the State Construction Office website. Public
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
346
announcement is required prior to Construction Manager-at-Risk
selection. The closing date for being considered for construction
management-at-risk services shall be minimum of 21 days from
date of publication on the State Construction Office website.
Responses to RFP for each project must be received by the
Capital Project Coordinator prior to a firm's being considered for
construction management-at-risk services.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
SECTION .0300 - SELECTION OF CONSTSRUCTION
MANAGERS AT RISK
01 NCAC 30J .0301 CONSTRUCTION MANAGER-AT-
RISK QUALIFICATIONS
All firms desiring to provide construction management-at-risk
services shall submit all information required in the Request for
Proposal (RFP) for the owner's review and evaluation. Firms
shall be required to submit evidence of compliance with the
minimum requirements of the RFP. Each firm shall meet the
minimum requirements of the RFP prior to being considered by
the selection committee as one of the firms most qualified to
perform construction manager-at-risk services. Failure of any
firm to furnish all necessary information in the RFP shall
disqualify response.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0302 PRE-SELECTION COMMITTEE
A pre-selection committee shall be established for all projects
requiring construction management-at-risk services. The pre-selection
committee shall consist of at least the capital projects
coordinator, a representative of the using agency and one
representative from the State Construction Office. At least one
member of all pre-selection committees shall be a licensed
design or construction professional. The pre-selection committee
shall review the requirements of a specific project and the
qualification of all firms expressing interest in that project and
shall select from that list not more than six nor less than three
firms to be interviewed and evaluated. The pre-selection
committee shall interview each of the selected firms, evaluate
each firm interviewed, and rank in order three firms. The capital
projects coordinator shall state in his submission that the
established rules for public announcement and selection have
been followed or shall state full particulars if exceptions have
been taken.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0303 SELECTING CRITERIA
In selecting the three firms to be presented to the SBC, the pre-selection
committee should take into consideration in the
evaluation of the Proposals such factors as:
(1) Workload that is fully able to accommodate
the addition of this project;
(2) Record of successfully completed projects of
similar scope without major legal or technical
problems ;
(3) Previous experience with the Owner, a good
working relationship with Owner
representatives, have completed projects in a
timely manner and have performed an
acceptable quality of work;
(4) Key personnel that have appropriate
experience and qualifications;
(5) Relevant and easily understood graphic or
tabular presentations;
(6) Completion of CM-at-Risk projects in which
there was little differences between the GMP
and final cost;
(7) Projects that were completed on or ahead of
schedule;
(8) Recent experience with project costs and
schedules;
(9) Construction administration capabilities;
(10) Proximity to and familiarity with the area
where the project is located;
(11) Quality of compliance plan for minority
business participation as required by G.S. 143-
128.2; and
(12) Other factors that may be appropriate for the
project.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0304 CONSTRUCTION MANAGER-AT-
RISK SELECTION FOR UNC SYSTEM PROJECTS
In selecting Construction Manager-at-Risk for its projects, the
UNC system shall comply with the policies and selection
procedures outlined herein, except that:
(1) the pre-selection committees need not include
a representative of the State Construction
Office; and
(2) the final selection of Construction Manager-at-
Risk shall be made by the Board of Trustees of
the funded institution.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
01 NCAC 30J .0305 CONSTRUCTION MANAGER-AT-
RISK SELECTION FOR OTHER THAN UNC
SYSTEM PROJECTS
Upon receipt of a letter from the capital projects coordinator
listing three firms in priority order along with recommendations
and selection information, as requested by the SBC, the secretary
of SBC, upon determination that all information has been
submitted, will place the request for consideration on the agenda
for the next SBC meeting. The capital projects coordinator shall
make a report to the SBC outlining the procedures that were
followed and justification for the priority list of three firms.
Upon a determination by the SBC that the standard procedures
and criteria have been properly followed, the SBC will:
(1) Affirm the selection of the firms in the priority
order recommended by the state or agency; or
(2) Select the firms in a different priority order
from that recommended by the funded agency
and give justification for such selection; or
(3) Request a new priority list and give
justification for such request.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
347
01 NCAC 30J .0306 CONTRACT NEGOTIATION
After the three have been notified of the selection action by the
SBC or the University of North Carolina, a representative from
the State Construction Office, the capital projects coordinator,
and a representative from the using agency shall discuss with the
selected construction manager-at-risk appropriate services and
information about the project. The State Construction Office
shall request in writing a detailed fee proposal from the selected
Construction Manager-at-Risk. The State Construction Office in
coordination with the capital projects coordinator and the using
agency will attempt to negotiate a fair and equitable fee
consistent with the project program and the professional services
required for the specific project. In the event a fee cannot be
agreed upon, the State Construction Office shall terminate the
negotiations and shall repeat the notification and negotiation
process with the next ranked firm on the selection list. In the
event a fee cannot be agreed upon with the second-ranked
Construction Manager-at-Risk, the process will be repeated with
the third-ranked Construction Manager-at-Risk. If a fee still
cannot be agreed upon, the SBC shall review the history of
negotiations and make appropriate determinations including
program adjustments so as to lead to a negotiated contract with
one of the original three firms selected. Such renegotiation with
the firms shall be carried out in the original selection order, or
call shall be made for the capital projects coordinator to submit
another list of three firms in priority order to the SBC or to the
UNC system. The negotiation process shall continue until a fee
has been determined that is agreed to by the State Construction
Office, the using agency and the Construction Manager-at-Risk.
Following execution of the contract, the State Construction
Office shall publish on the State Construction Office website,
the list of three firms selected in priority order, the firm to be
contracted with, and the fee negotiated.
Authority G.S. 143-135.26; S.L. 2001-496, s. 11.
TITLE 10A – DEPARTMENT OF HEALTH AND HUMAN
SERVICES
Notice is hereby given in accordance with G.S. 150B-21.2 that
the NC Medical Care Commission intends to amend the rule
cited as 10A NCAC 13J .1302.
Proposed Effective Date: January 1, 2004
Public Hearing:
Date: November 6, 2003
Time: 2:00 p.m.
Location: Room 201, Council Building, Dorothea Dix campus,
701 Barbour Dr. Raleigh, NC
Reason for Proposed Action: The NC Medical Care
Commission proposes to amend this Rule. This Rule pertains to
the policy/procedure for obtaining a physician's
countersignature on verbal orders. The suggested amendment
will clarify under which circumstances a physician's signature is
necessary. This action will replace and supersede an earlier
amendment to the same rule approved by the NC Medical Care
Commission and the Rules Review Commission which would be
effective July 1, 2004.
Comment Procedures: Comments from the public shall be
directed to Mark T. Benton, 2701 Mail Service Center, Division
of Facility Services, Raleigh, NC 27699-2701, phone (919) 855-
3750, fax (919) 733-2757, and email mark.benton@ncmail.net.
Comment period ends November 6, 2003.
Procedure for Subjecting a Proposed Rule to Legislative
Review: Any person who objects to the adoption of a permanent
rule may submit written comments to the agency. A person may
also submit written objections to the Rules Review Commission.
If the Rules Review Commission receives written and signed
objections in accordance with G.S. 150B-21.3(b2) from 10 or
more persons clearly requesting review by the legislature and the
Rules Review Commission approves the rule, the rule will
become effective as provided in G.S. 150B-21.3(b1). The
Commission will receive written objections until 5:00 p.m. on
the 6th business day preceding the end of the month in which a
rule is approved. The Commission will receive those objections
by mail, delivery service, hand delivery, or facsimile
transmission. If you have any further questions concerning the
submission of objections to the Commission, please call a
Commission staff attorney at 919-733-2721.
Fiscal Impact
State
Local
Substantive (>$3,000,000)
None
CHAPTER 13 – NC MEDICAL CARE COMMISSION
SUBCHAPTER 13J - THE LICENSING OF HOME CARE
AGENCIES
SECTION .1300 - PHARMACEUTICALS AND MEDICAL
TREATMENT ORDERS
10A NCAC 13J .1302 ORDERS
(a) Orders for pharmaceuticals and medical treatments
treatments, or orders for in-home aide services when orders
for in-home aide services are required, shall be signed by
the physician or other person authorized by State law to
prescribe such treatments and the original incorporated in
the client's service records. Care may commence in the
interim with evidence of a verbal order.
(b) Verbal orders for the administration of pharmacological
agents and other medical treatment interventions shall be
given to a licensed nurse, or other person authorized by state
law to receive such orders. orders recorded and signed by
the person receiving it and countersigned by the physician
or other person authorized by State law to prescribe within
30 days. The order shall include the date and signature of
the person receiving the order, shall be recorded in the client
record, and shall be countersigned by the physician or other
person authorized by State law to prescribe.
(c) Verbal orders for allied health services personnel, other
than nursing or other than in-home aide services when
orders are required, services, shall be given to either a
licensed nurse or the appropriate health professional,
recorded in the client record and signed by the person
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
348
receiving it and countersigned by the physician or other
person authorized by State law to prescribe within 30 days
from the time given. professional. The order shall include
the date and signature of the person receiving the order,
shall be recorded in the client record and shall be
countersigned by the physician or other person authorized
by State law to prescribe.
(d) The home care agency shall develop and implement
written policies and procedures for obtaining
countersignatures on verbal orders within 60 days of the
date of the verbal order.
Authority G.S. 131E-140.
* * * * * * * * * * * * * * * * * * * *
Notice is hereby given in accordance with G.S. 150B-21.2 that
the NC Medical Care Commission intends to adopt the rules
cited as 10A NCAC 13P .0121-.0122, .0201-.0202, .0301, .0501-
.0502, .0504, .0507-.0508, .0510, .0601-.0603, .0701, amend the
rules cited as 10A NCAC 13P .0101, .0106, .0114, .0119, .0203-
.0205, .0207-.0211, .0214, .0303, .0401-.0403, .0405-.0409,
.0506, .0509, .0901-.0903, .0905, .1103, and repeal the rules
cited as 10A NCAC 13P .0108, .0604, .1201-.1203, .1301.
Proposed Effective Date: January 1, 2004
Public Hearing:
Date: November 6, 2003
Time: 3:30 p.m.
Location: Division of Facility Services, Room 201, Council
Building, Dorothea Dix campus, 701 Barbour Drive, Raleigh,
NC
Reason for Proposed Action: The NC Medical Care
Commission is proposing to adopt, amend and repeal rules
found in 10A NCAC 13P. This Subchapter pertains to
Emergency Medical Services (EMS). The specifics of this rule-making
action are: (a) The changes to rules .0108, .0121-.0122,
.0201-.0202, .0301, .0501-.0502, .0504, .0507-.0508, .0601-
.0603, .0701 were prompted by SL 2003-392 (SB 661). This
legislation authorized the NC Medical Care Commission to
establish occupational standards for EMS systems, EMS
educational institutions and specialty care transport programs.
The action on these specific rules will replace and supersede
earlier action of the same rules that are pending legislative
review and would have been effective August 2004. (b) The
adoption of a new rule at 10A NCAC 13P .0510 and
amendments to existing rules 10A NCAC 13P .0101, .0106,
.0119, .0203, .0401-.0403, .0408-.0409, .0510, .1103 were also
prompted by SB 661. This legislation authorized the NC
Medical Care Commission to set the criteria for the
education/credentialing of EMS instructors, establish an "EMS
Peer Review Committee," delete the EMT-D level of care, and
remove credentialing (by the state) for MICN, EMS-PA and
EMS-NP. (c) The repeal of, and amendments to, 10A NCAC
13P .0114, .0204-.0205, .0207-.0211, .0214, .0303, .0405-.0407,
.0506, .0509, .0604, .0901-.0903, .0905, .1201-.1203 and .1301
were not prompted by SB 661. Rather, these changes are
technical in nature and are limited to removing
transitional/dated material, inserting abbreviations, etc.
Comment Procedures: Written comments should be submitted
to Mark Benton, NC Division of Facility Services, 2701 MSC,
Raleigh, NC 27699-2701. Phone: (919) 855-3750, fax: (919)
733-2757, email: mark.benton@ncmail.net. Comments should
be submitted through November 6, 2003.
Procedure for Subjecting a Proposed Rule to Legislative
Review: Any person who objects to the adoption of a permanent
rule may submit written comments to the agency. A person may
also submit written objections to the Rules Review Commission.
If the Rules Review Commission receives written and signed
objections in accordance with G.S. 150B-21.3(b2) from 10 or
more persons clearly requesting review by the legislature and the
Rules Review Commission approves the rule, the rule will
become effective as provided in G.S. 150B-21.3(b1). The
Commission will receive written objections until 5:00 p.m. on
the 6th business day preceding the end of the month in which a
rule is approved. The Commission will receive those objections
by mail, delivery service, hand delivery, or facsimile
transmission. If you have any further questions concerning the
submission of objections to the Commission, please call a
Commission staff attorney at 919-733-2721.
Fiscal Impact
State
Local
Substantive (>$3,000,000)
None
CHAPTER 13 – FACILITY SERVICES
SUBCHAPTER 13P – EMERGENCY MEDICAL
SERVICES
SECTION .0100 - DEFINITIONS
10A NCAC 13P .0101 ABBREVIATIONS
As used in this Subchapter, the following abbreviations mean:
(1) AHA: American Heart Association;
(2) CPR: Cardiopulmonary Resuscitation.
(3) EMD: Emergency Medical Dispatcher;
(4) EMDPRS: Emergency Medical Dispatch
Priority Reference System;
(5) EMS: Emergency Medical Services;
(6) EMS-NP: EMS Nurse Practitioner;
(7) EMS-PA: EMS Physician Assistant;
(8) EMT: Emergency Medical Technician;
(9) EMT-D: EMT-Defibrillation;
(10)(9) EMT-I: EMT-Intermediate;
(11)(10) EMT-P: EMT-Paramedic;
(12)(11) MICN: Mobile Intensive Care Nurse;
(13)(12) MR: Medical Responder; and
(13) NHTSA: National Highway Traffic Safety
Administration
(14) OEMS: Office of Emergency Medical
Services; and
(15) US DOT: United States Department of
Transportation.
Authority G.S. 143-508(b).
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
349
10A NCAC 13P .0106 EDUCATIONAL MEDICAL
ADVISOR
As used in this Subchapter, "Educational Medical Advisor"
means the physician responsible for overseeing the medical
components of approved EMS educational programs in
continuing education, basic, and advanced EMS educational
institutions.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13).
10A NCAC 13P .0108 EMS INSTRUCTOR
"EMS Instructor" means a person who is credentialed by the
OEMS as a Level I or II EMS Instructor or EMD Instructor and
who is approved to instruct or coordinate EMS educational
programs.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(4);
131E-155(a)(7a).
10A NCAC 13P .0114 MEDICAL OVERSIGHT
As used in this Subchapter, "Medical Oversight" means the
responsibility for the management and accountability of the
medical care aspects of an EMS System. System or Specialty
Care Transport Program. Medical Oversight includes physician
direction of the initial education and continuing education of
EMS personnel;personnel or medical crew members;
development and monitoring of both operational and treatment
protocols; evaluation of the medical care rendered by EMS
personnel;personnel or medical crew members; participation in
system or program evaluation; and directing, by two-way voice
communications, the medical care rendered by the EMS
personnel.personnel or medical crew members.
Authority G.S. 143-508(b).
10A NCAC 13P .0119 EMS PEER REVIEW
COMMITTEE
As used in this Subchapter, "Quality Management""EMS Peer
Review Committee" means a committee as defined in G.S.
131E-155(a)(16a).within an EMS System or Specialty Care
Transport Program that is affiliated with a medical review
committee as referenced in G.S. 143-518(a)(5) and is
responsible for the continued monitoring and evaluation of
medical and operational issues within the system and for
improvement of the system.
Authority G.S. 143-508(b); 143-518(a)(5); 131E-155(a)(16a).
10A NCAC 13P .0121 SPECIALTY CARE TRANSPORT
PROGRAM CONTINUING EDUCATION
COORDINATOR
As used in this Subchapter, "Specialty Care Transport Program
Continuing Education Coordinator" means a Level I EMS
Instructor within a specialty care transport program who is
responsible for the coordination of EMS continuing education
programs for EMS personnel within the program.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13).
10A NCAC 13P .0122 SYSTEM CONTINUING
EDUCATION COORDINATOR
As used in this Subchapter, "System Continuing Education
Coordinator" means a Level I EMS Instructor within a Model
EMS System who is responsible for the coordination of EMS
continuing education programs.
Authority G.S. 143-508(b); 143-508(d)(3); 143-508(d)(13).
SECTION .0200 – EMS SYSTEMS
10A NCAC 13P .0201 EMS SYSTEM REQUIREMENTS
(a) County government shall establish EMS Systems . Each
EMS System shall have:
(1) a defined geographical service area for the
EMS System. The minimum service area for
an EMS System shall be one county. There
may be multiple EMS provider service areas
within the service area of an EMS System.
The highest level of care offered within any
EMS provider service area must be available
to the citizens within that service area 24 hours
per day;
(2) a scope of practice within the parameters
defined by the North Carolina Medical Board
pursuant to G.S. 143-514;
(3) a written plan describing the dispatch and
coordination of all responders that provide
EMS care within the system;
(4) a minimum of one licensed EMS provider.
For those systems with providers operating
within the EMD, EMT-I, or EMT-P scope of
practice, there shall be a plan for medical
oversight required by Section .0400 of this
Subchapter;
(5) an identified number of permitted ambulances
to provide coverage to the service area 24
hours per day;
(6) personnel credentialed to perform within the
scope of practice of the system and to staff the
ambulance vehicles as required by G.S. 131E-
158. There shall be a written plan for the use
of credentialed EMS personnel for all practice
settings used within the system;
(7) a mechanism to collect and electronically
submit to the OEMS data that uses the basic
data set and data dictionary as specified in
"North Carolina College of Emergency
Physicians: Standards for Medical Oversight
and Data Collection," incoporated by reference
in accordance with G.S. 150B-21.6, including
subsequent amendments and additions. This
document is available from the OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost. EMS Systems shall
comply with this requirement by July 1, 2004;
(8) a written infection control policy that
addresses the cleansing and disinfecting of
vehicles and equipment that are used to treat or
transport patients;
(9) a written plan to provide orientation to
personnel on EMS operations and related
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
350
issues for hospitals routinely receiving patients
from the EMS System;
(10) a listing of facilities that will provide online
medical direction for systems with providers
operating within the EMT, EMT-I, or EMT-P
scope of practice. To provide online medical
direction, the facility shall have:
(A) availability of a physician, MICN,
EMS-NP, or EMS-PA to provide
online medical direction to EMS
personnel during all hours of
operation of the facility;
(B) a written plan to provide physician
backup to the MICN, EMS-NP, or
EMS-PA providing online medical
direction to EMS personnel;
(C) a mechanism for persons providing
online medical direction to provide
feedback to the EMS Peer Review
Committee; and
(D) a written plan to provide orientation
and education regarding treatment
protocols for those individuals
providing online medical direction;
(11) a written plan to ensure that each facility
which routinely receives patients and also
offers clinical education for EMS personnel
provides orientation and education to all
preceptors regarding requirements of the EMS
System;
(12) a written plan for providing emergency vehicle
operation education for system personnel who
operate emergency vehicles;
(13) an EMS communication system that provides
for:
(A) public access using the emergency
telephone number 9-1-1 within the
public dial telephone network as the
primary method for the public to
request emergency assistance. This
number shall be connected to the
emergency communications center or
Public Safety Answering Point
(PSAP) with immediate assistance
available such that no caller will be
instructed to hang up the telephone
and dial another telephone number.
A person calling for emergency
assistance shall never be required to
speak with more than two persons to
request emergency medical
assistance;
(B) an emergency communications
system operated by public safety
telecommunicators with training in
the management of calls for medical
assistance available 24 hours per day;
(C) dispatch of the most appropriate
emergency medical response unit or
units to any caller's request for
assistance. The dispatch of all
response vehicles shall be in
accordance with an official written
EMS System plan for the
management and deployment of
response vehicles including requests
for mutual aid; and
(D) two-way radio voice communications
from within the defined service area
to the emergency communications
center or PSAP and to facilities where
patients are routinely transported.
The emergency communications
system shall maintain all Federal
Communications Commission (FCC)
radio licenses or authorizations
required;
(14) a written plan addressing the use of Specialty
Care Transport Programs within the system;
(15) a written continuing education plan for
credentialed EMS personnel that follows the
guidelines of the:
(A) "US DOT NHTSA First Responder
Refresher: National Standard
Curriculum" for MR personnel;
(B) "US DOT NHTSA EMT-Basic
Refresher: National Standard
Curriculum" for EMT personnel;
(C) "EMT-P and EMT-I Continuing
Education National Guidelines" for
EMT-I and EMT-P personnel; and
(D) "US DOT NHTSA Emergency
Medical Dispatcher: National
Standard Curriculum" for EMD
personnel.
These documents are incoporated by reference
in accordance with G.S. 150B-21.6, including
subsequent amendments and additions. These
documents are available from NHTSA, 400
7th Street, SW, Washington, D.C. 20590, at no
cost; and
(16) a written plan addressing the orientation of
MICN, EMS-NP, or EMS-PA used in the
system. The orientation program shall include
the following:
(A) a discussion of all EMS System
treatment protocols and procedures;
(B) an explanation of the specific scope
of practice for credentialed EMS
personnel, as authorized by the
approved treatment protocols;
(C) a discussion of all practice settings
within the EMS System and how
scope of practice may vary in each
setting;
(D) a mechanism to assess the student's
ability to effectively use EMS System
communications equipment including
hospital and prehospital devices,
EMS communication protocols, and
communications contingency plans as
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
351
related to on-line medical direction;
and
(E) the successful completion of a scope
of practice evaluation administered
under the direction of the medical
director.
(b) An application to establish an EMS System shall be
submitted by the county to the OEMS for review. When the
system is comprised of more than one county, only one
application shall be submitted. The proposal shall demonstrate
that the system meets the requirements in Paragraph (a) of this
Rule. System approval shall be granted for a period of six years.
Systems shall apply to OEMS for reapproval.
Authority G.S. 131E-155(a)(8), (a)(9), (a)(15);
143-508(b); (d)(1), (d)(5), (d)(9); 143-509(1); 143-517.
10A NCAC 13P .0202 MODEL EMS SYSTEMS
(a) Some EMS Systems may choose to move beyond the
minimum requirements in Rule .0201 of this Section and receive
designation from the OEMS as a Model EMS System. To
receive this designation, an EMS System shall document that, in
addition to the system requirements in Rule .0201 of this
Section, the following criteria have been met:
(1) a uniform level of care throughout the system
available 24 hours per day;
(2) a plan for medical oversight that meets the
requirements found in Section .0400 of this
Subchapter. Specifically, Model EMS
Systems shall meet the additional requirements
for medical director and written treatment
protocols as defined in Rules .0401(1)(b) and
.0405(a)(2) of this Subchapter;
(3) a mechanism to collect and electronically
submit to the OEMS data corresponding to the
advanced data set and data dictionary as
specified in "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incoporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
additions. This document is available from the
OEMS, 2707 Mail Service Center, Raleigh,
North Carolina 27699-2707, at no cost;
(4) a written plan to address management of the
EMS System to include:
(A) triage of patients to appropriate
facilities;
(B) transport of patients to facilities
outside of the system;
(C) arrangements for transporting patients
to appropriate facilities when
diversion or bypass plans are
activated;
(D) a mechanism for reporting,
monitoring, and establishing
standards for system response times;
(E) a disaster plan; and
(F) a mass-gathering plan;
(5) a written continuing education plan for EMS
personnel, under the direction of the System
Continuing Education Coordinator, developed
and modified based on feedback from system
data, review, and evaluation of patient
outcomes and quality management reviews;
(6) a written plan to assure participation in clinical
and field internship educational components
for all EMS personnel;
(7) operational protocols for the management of
equipment, supplies and medications. These
protocols shall include a methodology:
(A) to assure that each vehicle contains
the required equipment and supplies
on each response;
(B) for cleaning and maintaining the
equipment and vehicles; and
(C) to assure that supplies and
medications are not used beyond the
expiration date and stored in a
temperature controlled atmosphere
according to manufacturer's
specifications;
(8) a written plan for the systematic and periodic
inspection, repair and maintenance of all
vehicles used in the system;
(9) a written plan addressing the role of the EMS
System in the areas of public education, injury
prevention, and community health;
(10) affiliation with a minimum of one trauma
Regional Advisory Committee; and
(11) a system-wide communication system which
meets the requirements of Paragraph (a)(13) of
Rule .0201 of this Section, and in addition:
(A) operates an EMD program; and
(B) has an operational E-911 system.
(b) EMS Systems holding current accreditation by a national
accreditation agency may use this as documentation of
completion of the equivalent requirements outlined in this Rule.
(c) The county shall submit an application for designation as a
Model EMS System to the OEMS for review. When the system
is comprised of more than one county, only one application shall
be submitted. The application shall demonstrate that the system
meets the standards found in Paragraph (a) of this Rule.
Designation as a Model EMS System shall be awarded for a
period of six years. Systems shall apply to OEMS for model
system redesignation.
Authority G.S. 143-508(b); (d)(1), (d)(5), (d)(9); (d)(13);
143-509(1).
10A NCAC 13P .0203 SPECIAL SITUATIONS
Upon application of citizens in North Carolina, the North
Carolina Medical Care Commission shall approve the furnishing
and providing of programs within the scope of practice of EMD,
EMT, EMT-D, EMT-I, or EMT-P in North Carolina by persons
who have been approved to provide these services by an agency
of a state adjoining North Carolina or federal jurisdiction. This
approval shall be granted where the North Carolina Medical
Care Commission concludes that the requirements enumerated in
Rule .0201 of this Subchapter cannot be reasonably obtained by
reason of lack of geographical access.
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18:05 NORTH CAROLINA REGISTER September 2, 2003
352
Authority G.S. 143-508(b).
10A NCAC 13P .0204 EMS PROVIDER LICENSE
REQUIREMENTS
(a) Any firm, corporation, agency, organization or association
that provides emergency medical services as its primary
responsibility shall be licensed as an EMS providerProvider by
meeting the following criteria:
(1) Be affiliated with an EMS System. System;
Providers that apply for an initial EMS
Provider License shall have until July 1, 2003,
to comply with this requirement in the absence
of an approved county system plan. Providers
that apply for an initial EMS Provider License
after July 1, 2003, shall comply with all
requirements of this Rule;
(2) Present an application for a permit for any
ambulance that will be in service as required
by G.S. 131E-156;
(3) Submit a written plan detailing how the
providerProvider will furnish credentialed
personnel;
(4) Where there is a franchise ordinance in effect
which covers the proposed service area, be
granted a current franchise to operate or
present written documentation of impending
receipt of a franchise from the county; and
(5) Present a written plan and method for
recording systematic, periodic inspection
repair, cleaning, and routine maintenance of all
EMS responding vehicles.
(b) An EMS providerProvider may renew its license by
presenting documentation to the OEMS that the
providerProvider meets the criteria found in Paragraph (a) of this
Rule.
Authority G.S. 131E-155.1(c).
10A NCAC 13P .0205 EMS PROVIDER LICENSE
CONDITIONS
(a) Applications for an EMS Provider License must be received
by the OEMS at least 30 days prior to the date that the
providerProvider proposes to initiate service. Applications for
renewal of an EMS Provider License must be received by the
OEMS at least 30 days prior to the expiration date of the current
license.
(b) Only one license shall be issued to each EMS
provider.Provider. The Department shall issue a license to the
EMS providerProvider following verification of compliance
with applicable laws and rules.
(c) EMS Provider Licenses shall not be transferred.
(d) The license shall be posted in a prominent location
accessible to public view at the primary business location of the
EMS provider.Provider.
(e) In order to provide a transition time for implementation of
this Rule, EMS Provider Licenses obtained prior to the approval
of the EMS System Plan for the county or counties served by the
provider shall remain current until such time as the EMS System
Plan is approved.
Authority G.S. 131E-155.1(c).
10A NCAC 13P .0207 GROUND AMBULANCE:
VEHICLE AND EQUIPMENT REQUIREMENTS
(a) To be permitted as a Ground Ambulance, a vehicle shall
have:
(1) a patient compartment that meets the following
minimum interior dimensions:
(A) the length, measured on the floor
from the back of the driver's
compartment, driver's seat or partition
to the inside edge of the rear loading
doors, shall be at least 102 inches;
and
(B) the height shall be at least 48 inches
over the patient area, measured from
the approximate center of the floor,
exclusive of cabinets or equipment;
(2) patient care equipment and supplies as defined
in the treatment protocols for the system.
Vehicles used by EMS providers that are not
required to have treatment protocols shall have
patient care equipment and supplies as defined
in the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight
and Data Collection," incorporated by
reference in accordance with G.S. 150B-21.6,
including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost. The
equipment and supplies shall be clean, in
working order, and secured in the vehicle;
(3) other equipment to include:
(A) one fire extinguisher mounted in a
quick release bracket that shall either
be a dry chemical or all-purpose type
and have a pressure gauge; and
(B) the availability of one pediatric
restraint device to safely transport
pediatric patients under 20 pounds in
the patient compartment of the
ambulance;
(4) the name of the ambulance provider
permanently displayed on each side of the
vehicle;
(5) reflective tape affixed to the vehicle such that
there is reflectivity on all sides of the vehicle;
(6) emergency warning lights and audible warning
devices mounted on the vehicle as required by
G.S. 20-125 in addition to those required by
Federal Motor Vehicle Safety Standards. All
warning devices shall function properly;
(7) no structural or functional defects that may
adversely affect the patient, the EMS
personnel, or the safe operation of the vehicle;
(8) an operational two-way radio that shall:
(A) be mounted to the ambulance and
installed for safe operation and
controlled by the ambulance driver;
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18:05 NORTH CAROLINA REGISTER September 2, 2003
353
(B) have sufficient range, radio
frequencies, and capabilities to
establish and maintain two-way voice
radio communication from within the
defined service area of the EMS
System to the emergency
communications center or public
safety answering point (PSAP)
designated to direct or dispatch the
deployment of the ambulance;
(C) be capable of establishing two-way
voice radio communication from
within the defined service area to the
emergency department of the
hospital(s) where patients are
routinely transported and to facilities
that provide on-line medical direction
to EMS personnel;
(D) be equipped with a radio control
device mounted in the patient
compartment capable of operation by
the patient attendant to receive on-line
medical direction; and
(E) be licensed or authorized by the
Federal Communications
Commission (FCC).
(b) Ground ambulances shall not use a radiotelephone device
such as a cellular telephone as the only source of two-way radio
voice communication.
(c) Other communication instruments or devices such as data
radio, facsimile, computer, or telemetry radio shall be in addition
to the mission dedicated dispatch radio and shall function
independently from the mission dedicated radio.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0208 CONVALESCENT
AMBULANCE: VEHICLE AND EQUIPMENT
REQUIREMENTS
(a) To be permitted as a Convalescent Ambulance, a vehicle
shall have:
(1) a patient compartment that meets the following
minimum interior dimensions:
(A) the length, measured on the floor
from the back of the driver's
compartment, driver's seat or partition
to the inside edge of the rear loading
doors, shall be at least 102 inches;
and
(B) the height shall be at least 48 inches
over the patient area, measured from
the approximate center of the floor,
exclusive of cabinets or equipment;
(2) patient care equipment and supplies as defined
in the treatment protocols for the system.
Vehicles used by EMS providers that are not
required to have treatment protocols shall have
patient care equipment and supplies as defined
in the "North Carolina College of Emergency
Physicians: Standards for Medical Oversight
and Data Collection," incorporated by
reference in accordance with G.S. 150B-21.6,
including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost. The
equipment and supplies shall be clean, in
working order, and secured in the vehicle;
(3) other equipment to include:
(A) one fire extinguisher mounted in a
quick release bracket that shall either
be a dry chemical or all-purpose type
and have a pressure gauge; and
(B) the availability of one pediatric
restraint device to safely transport
pediatric patients under 20 pounds in
the patient compartment of the
ambulance.
(b) Convalescent Ambulances shall:
(1) not be equipped, permanently or temporarily,
with any emergency warning devices, audible
or visual, other than those required by Federal
Motor Vehicle Safety Standards;
(2) have the name of the ambulance provider
permanently displayed on each side of the
vehicle;
(3) not have emergency medical symbols, such as
the Star of Life, block design cross, or any
other medical markings, symbols, or emblems,
including the word "EMERGENCY," on the
vehicle;
(4) have the words "CONVALESCENT
AMBULANCE" lettered on both sides and on
the rear of the vehicle body; and
(5) have reflective tape affixed to the vehicle such
that there is reflectivity on all sides of the
vehicle.
(c) A two-way radio or radiotelephone device such as a cellular
telephone shall be available to summon emergency assistance
for a vehicle permitted as a convalescent ambulance.
(d) The convalescent ambulance shall not have structural or
functional defects that may adversely affect the patient, the EMS
personnel, or the safe operation of the vehicle.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0209 AIR MEDICAL AMBULANCE:
VEHICLE AND EQUIPMENT REQUIREMENTS
To be permitted as an Air Medical Ambulance, an aircraft shall
meet the following requirements:
(1) Configuration of the aircraft interior shall not
compromise the ability to provide appropriate
care or prevent providers from performing
emergency procedures if necessary.
(2) The aircraft shall have on board patient care
equipment and supplies as defined in the
treatment protocols for the program. Air
Medical Ambulances used by EMS providers
that are not required to have treatment
protocols shall have patient care equipment
and supplies as defined in the "North Carolina
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18:05 NORTH CAROLINA REGISTER September 2, 2003
354
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection,"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the Office of Emergency
Medical Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost. The equipment and supplies shall
be clean, in working order, and secured in the
vehicle.
(3) There shall be installed in the aircraft an
internal voice communication system to allow
for communication between the medical crew
and flight crew.
(4) Due to the different configurations and space
limitations of air medical ambulances, the
medical director shall designate the
combination of medical equipment specified in
Item (2) of this Rule that is carried on a
mission based on anticipated patient care
needs.
(5) Air Medical Ambulances shall have the name
of the organization permanently displayed on
each side of the aircraft.
(6) Air Medical Ambulances shall be equipped
with a two-way voice radio licensed by the
Federal Communications Commission capable
of operation on any frequency required to
allow communications with public safety
agencies such as fire departments, police
departments, ambulance and rescue units,
hospitals, and local government agencies
within the defined service area.
(7) All rotary wing aircraft permitted as an air
medical ambulance shall have the following
flight equipment operational in the aircraft:
(a) Twotwo 360-channel VHF aircraft
frequency transceivers;
(b) Oneone VHF omnidirectional ranging
(VOR) receiver;
(c) Attitudeattitude indicators;
(d) Oneone transponder with 4097 code,
Mode C with altitude encoding;
(e) Turnturn and slip indicator in the
absence of three attitude indicators;
(f) Currentcurrent FAA approved
navigational aids and charts for the
area of operations;
(g) Radarradar altimeter;
(h) Satellite Global Navigational System;
(i) Emergency Locator Transmitter
(ELT);
(j) Aa remote control external search
light;
(k) Aa light which illuminates the tail
rotor;
(l) Aa fire extinguisher; and
(m) Survivalsurvival gear appropriate for
the service area and the number of
occupants.
(8) Any fixed wing aircraft issued a permit to
operate as an air medical ambulance shall have
a current "Instrument Flight Rules"
certification.
(9) The availability of one pediatric restraint
device to safely transport pediatric patients
under 20 pounds in the patient compartment of
the air medical ambulance.
(10) The Air Medical Ambulance shall not have
structural or functional defects that may
adversely affect the patient, the EMS
personnel, or the safe operation of the aircraft.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0210 WATER AMBULANCE:
WATERCRAFT AND EQUIPMENT REQUIREMENTS
To be permitted as a Water Ambulance, a watercraft shall meet
the following requirements:
(1) The watercraft shall have a patient care area
that:
(a) provides access to the head, torso,
and lower extremities of the patient
while providing sufficient working
space to render patient care;
(b) is covered to protect the patient and
EMS personnel from the elements;
and
(c) has an opening of sufficient size to
permit the safe loading and unloading
of a person occupying a litter.
(2) The watercraft shall have on board patient care
equipment and supplies as defined in the
treatment protocols for the system. Water
ambulances used by EMS providers that are
not required to have treatment protocols shall
have patient care equipment and supplies as
defined in the "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost. The
equipment and supplies shall be clean, in
working order, and secured in the vehicle.
(3) Water ambulances shall have the name of the
ambulance provider permanently displayed on
each side of the watercraft.
(4) Water ambulances shall have a 360-degree
beacon warning light in addition to warning
devices required in Chapter 75A, Article 1, of
the North Carolina General Statutes.
(5) Water ambulances shall be equipped with:
(a) two floatable rigid long backboards
with proper accessories for securing
infant, pediatric, and adult patients
and stabilization of the head and
neck;
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18:05 NORTH CAROLINA REGISTER September 2, 2003
355
(b) one floatable litter with patient
restraining straps and capable of
being secured to the watercraft;
(c) one fire extinguisher mounted in a
quick release bracket that shall either
be a dry chemical or all-purpose type
and have a pressure gauge;
(d) lighted compass;
(e) radio navigational aids such as ADF
(automatic directional finder),
Satellite Global Navigational System,
navigational radar, or other
comparable radio equipment suited
for water navigation;
(f) marine radio; and
(g) the availability of one pediatric
restraint device to safely transport
pediatric patients under 20 pounds in
the patient compartment of the
ambulance;
(6) The water ambulance shall not have structural
or functional defects that may adversely affect
the patient, the EMS personnel, or the safe
operation of the watercraft.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0211 AMBULANCE PERMIT
CONDITIONS
(a) An EMS provider shall apply to the OEMS for the
appropriate Ambulance Permit prior to placing an ambulance in
service.
(b) The Department shall issue a permit for an ambulance
following verification of compliance with applicable laws and
rules.
(c) Only one Ambulance Permit shall be issued for each
ambulance.
(d) An ambulance shall be permitted in only one category.
(e) Ambulance Permits shall not be transferred except in the
case of Air Medical Ambulance replacement aircraft when the
primary aircraft is out of service.
(f) The Ambulance Permit shall be posted as designated by the
OEMS inspector.
(g) In order to provide a transition time for implementation of
this Rule, Ambulance Permits obtained prior to the approval of
the EMS System Plan for the county or counties served by the
provider shall remain current until such time as the EMS System
Plan is approved.
Authority G.S. 131E-157(a); 143-508(d)(8).
10A NCAC 13P .0214 EMS NONTRANSPORTING
VEHICLE PERMIT CONDITIONS
(a) An EMS provider shall apply to the OEMS for an EMS
Nontransporting Vehicle Permit prior to placing such a vehicle
in service.
(b) The Department shall issue a permit for a vehicle following
verification of compliance with applicable laws and rules.
(c) Only one EMS Nontransporting Vehicle Permit shall be
issued for each vehicle.
(d) EMS Nontransporting Vehicle Permits shall not be
transferred.
(e) The EMS Nontransporting Vehicle Permit shall be posted as
designated by the OEMS inspector.
(f) In order to provide a transition time for implementation of
this Rule, EMS Nontransporting Vehicle Permits obtained prior
to the approval of the EMS System Plan for the county or
counties served by the provider shall remain current until such
time as the EMS System Plan is approved.
Authority G.S. 143-508(d)(8).
SECTION .0300 – SPECIALTY CARE TRANSPORT
PROGRAMS
10A NCAC 13P .0301 PROGRAM CRITERIA
(a) Programs seeking designation to provide specialty care
transports shall submit an application for program approval to
the OEMS at least 60 days prior to field implementation. The
application shall document that the program has:
(1) a defined service area;
(2) a medical oversight plan meeting the
requirements of Section .0400;
(3) service continuously available on a 24 hour
per day basis;
(4) the capability to provide the following patient
care skills and procedures:
(A) advanced airway techniques including
rapid sequence induction,
cricothyrotomy, and ventilator
management, including continuous
monitoring of the patient's
oxygenation;
(B) insertion of femoral lines;
(C) maintaining invasive monitoring
devices to include central venous
pressure lines, arterial and venous
catheters, arterial lines, intra-ventricular
catheters, and epidural
catheters; and
(D) interpreting 12-lead
electrocardiograms;
(5) a written continuing education plan for EMS
personnel, under the direction of the Specialty
Care Transport Program Continuing Education
Coordinator, developed and modified based on
feedback from program data, review and
evaluation of patient outcomes, and quality
management reviews; and
(6) a system to collect and submit by facsimile or
other electronic mans to the OEMS data that
uses the basic data set and data dictionary as
specified in "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
editions. This document is available from the
OEMS, 2707 Mail Service Center, Raleigh,
North Carolina 27699-2707, at no cost. EMS
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18:05 NORTH CAROLINA REGISTER September 2, 2003
356
Specialty Care Transport Programs shall
comply with this requirement by July 1, 2004.
(b) Applications for specialty care transport program approval
shall document that the applicant meets the requirements for the
specific program type or types applied for as specified in Rules
.0302, .0303 or .0304 of this Section.
(c) Specialty care transport program approval shall be valid for
a period to coincide with the EMS Provider License, not to
exceed six years. Programs shall apply to the OEMS for
reapproval.
Authority G.S. 143-508(d)(1), (d)(8), (d)(9); (d)(13).
10A NCAC 13P .0303 GROUND SPECIALTY CARE
TRANSPORT PROGRAMS
(a) When transporting patients that have a medical need for one
or more of the skills or procedures as defined for specialty care
transport programs in .0301(a)(4) of this Section, staffing for the
vehicle used in the ground specialty care transport program shall
be at a level to ensure the capability to provide in the patient
compartment, when the patient condition requires, two of the
following personnel approved by the medical director as medical
crew members:
(1) EMT-Paramedic;
(2) Nursenurse practitioner;
(3) Physician;physician
(4) Physicianphysician assistant;
(5) Registeredregistered nurse; and
(6) Respiratoryrespiratory therapist.
(b) When transporting patients that do not require specialty care
transport skills or procedures, staffing for the vehicles used in
the ground specialty care transport program shall be at a level to
ensure compliance with G.S. 131E-158(a).
(c) In addition to the general requirements of specialty care
transport programs in Rule .0301 of this Section, ground
programs providing specialty care transports shall document that
the program has:
(1) a communication system that will provide, at a
minimum, two-way voice communications to
medical crewmemberscrew members
anywhere in the service area of the program.
The medical director shall verify that the
communications system is satisfactory for on-line
medical direction;
(2) medical crewmemberscrew members that have
all completed training regarding:
(A) operation of the EMS
communications system used in the
program; and
(B) the medical and safety equipment
specific to the vehicles used in the
program. This training shall be
conducted every six months;
(3) Operationaloperational protocols for the
management of equipment, supplies and
medications. These protocols shall include:
(A) Aa standard equipment and supply
listing for all ambulance vehicles
used in the program. This listing
shall meet or exceed the requirements
for each category of ambulance used
in the program as found in Rules
.0207, .0208, .0209, and .0210 of this
Subchapter;
(B) Aa standard listing of medications for
all ambulance and EMS
nontransporting vehicles used in the
system. This listing shall be based on
the local treatment protocols and be
approved by the medical director;
(C) Aa methodology to assure that each
vehicle contains the required
equipment and supplies on each
response;
(D) Aa methodology for cleaning and
maintaining the equipment and
vehicles; and
(E) Aa methodology for assuring that
supplies and medications are not used
beyond the expiration date and stored
in a temperature controlled
atmosphere according to
manufacturer's specifications;
(4) Aa written plan for providing emergency
vehicle operation education for program
personnel who operate emergency vehicles;
and
(5) Aa written plan specifying how EMS Systems
will request ambulances operated by the
program.
(d) Ground Specialty Care Transport programs based outside of
North Carolina may be granted approval by the OEMS to
operate in North Carolina by submitting an application for
program approval. The application shall document that the
program meets all criteria specified in Rules .0204 and .0301 of
this Subchapter and Paragraphs (a) and (b) of this Rule.
Authority G.S. 143-508(d)(1), (d)(8), (d)(9).
SECTION .0400 -- MEDICAL OVERSIGHT
10A NCAC 13P .0401 COMPONENTS OF MEDICAL
OVERSIGHT FOR EMS SYSTEMS
Each EMS System operating within the scope of practice for
EMD, EMT-D, EMT-I, or EMT-P or seeking designation as a
Model EMS System shall have the following components in
place to assure medical oversight of the system:
(1) Aa medical director appointed, either directly
or by documented delegation, by the county
responsible for establishing the EMS System.
Systems may elect to appoint one or more
assistant medical directors.
(a) For EMS Systems, the medical
director and assistant medical
directors shall meet the criteria as
defined in the "North Carolina
College of Emergency Physicians:
Standards for Medical Oversight and
Data Collection," incorporated by
reference in accordance with G.S.
150B-21.6, including subsequent
amendments and editions. This
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18:05 NORTH CAROLINA REGISTER September 2, 2003
357
document is available from the Office
of Emergency Medical
Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina
27699-2707, at no cost; and
(b) For Model EMS Systems, the medical
director and assistant medical
directors shall also meet the
additional criteria for medical
directors of Model EMS Systems as
defined in the "North Carolina
College of Emergency Physicians:
Standards for Medical Oversight and
Data Collection," incorporated by
reference in accordance with G.S.
150B-21.6, including subsequent
amendments and editions. This
document is available from the Office
of Emergency Medical
Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina
27699-2707, at no cost;
(2) Writtenwritten treatment protocols for use by
EMS personnel;
(3) Forfor systems providing EMD service, an
EMDPRS approved by the medical director;
(4) A quality management committee;an EMS
Peer Review Committee; and
(5) Writtenwritten procedures for use by EMS
personnel to obtain on-line medical direction.
On-line medical direction shall:
(a) Bebe restricted to medical orders that
fall within the scope of practice of the
EMS personnel and within the scope
of approved system treatment
protocols;
(b) Bebe provided only by physicians, a
physician, MICN, EMS-NP, or EMS-PA.
EMS-physician assistants, EMS-nurse
practitioners, or mobile
intensive care nurses. Only
physicians may deviate from written
treatment protocols; and
(c) Bebe provided by a system of two-way
voice communication that can be
maintained throughout the treatment
and disposition of the patient.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0402 COMPONENTS OF MEDICAL
OVERSIGHT FOR SPECIALTY CARE TRANSPORT
PROGRAMS
Each Specialty Care Transport Program shall have the following
components in place to assure Medical Oversight of the system:
(1) Aa medical director. The administration of the
Specialty Care Transport Program shall
appoint a medical director following the
criteria for medical directors of Specialty Care
Transport Programs as defined by the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the Office of
Emergency Medical Services,OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost. The program
administration may elect to appoint one or
more assistant medical directors;
(2) Treatmenttreatment protocols for use by
medical crew members;
(3) A quality management committee;an EMS
Peer Review Committee; and
(4) Aa written protocol for use by medical crew
members to obtain on-line medical direction.
On-line medical direction shall:
(a) Bebe restricted to medical orders that
fall within the scope of practice of the
medical crew members and within the
scope of approved program treatment
protocols;
(b) Bebe provided only by physicians, a
physician, MICN, EMS-NP, or EMS-PA.
EMS-physician assistants, EMS-nurse
practitioners, or mobile
intensive care nurses. Only
physicians may deviate from written
treatment protocols; and
(c) Be obtained viabe provided by a
system of two-way voice
communication that can be
maintained throughout the treatment
and disposition of the patient.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0403 RESPONSIBILITIES OF THE
MEDICAL DIRECTOR FOR EMS SYSTEMS
(a) The medical directorMedical Director for an EMS
systemSystem shall be responsible for the following:
(1) Ensureensure that medical control is available
24 hours a day;
(2) Thethe establishment, approval and annual
updating of treatment protocols;
(3) For EMD programs, the establishment,
approval, and annual updating of the
EMDPRS;
(4) Medicalmedical supervision of the selection,
system orientation, continuing education and
performance of EMS personnel;
(5) Medicalmedical supervision of a scope of
practice performance evaluation for all EMS
personnel in the system based on the treatment
protocols for the system;
(6) Thethe medical review of the care provided to
patients;
(7) Providingproviding guidance regarding
decisions about the equipment, medical
supplies, and medications that will be carried
on ambulances or EMS nontransporting
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
358
vehicles within the scope of practice of EMT-D,
EMT-I, or EMT-P; EMT-I or EMT-P; and
(8) Keepingkeeping the care provided up to date
with current medical practice.
(b) Any tasks related to Paragraph (a) of this Rule may be
completed, through clearly established written delegation, by
assisting physicians, physician assistants, nurse practitioners,
registered nurses, EMD's, or EMT-P's.
(c) The medical directorMedical Director shall have the
authority to suspend temporarily, pending due process review,
any EMS personnel from further participation in the EMS
System when it is determined the activities or medical care
rendered by such personnel may be detrimental to the care of the
patient, constitute unprofessional behavior, or result in non-compliance
with credentialing requirements.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0405 REQUIREMENTS FOR
TREATMENT PROTOCOLS FOR EMS SYSTEMS
(a) Written Treatment Protocols:
(1) Used in EMS Systems shall meet the
minimum standard treatment protocols as
defined in the "North Carolina College of
Emergency Physicians: Standards for Medical
Oversight and Data Collection," incorporated
by reference in accordance with G.S. 150B-
21.6, including subsequent amendments and
editions. This document is available from the
Office of Emergency Medical Services,OEMS,
2707 Mail Service Center, Raleigh, North
Carolina 27699-2707, at no cost;
(2) Used in Model EMS Systems shall also meet
the minimum standard treatment protocols for
Model EMS Systems as defined in the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the Office of
Emergency Medical Services,OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(3) Shall not contain medical procedures,
medications, or intravenous fluids that exceed
the scope of practice defined by the North
Carolina Medical Board pursuant to G.S. 143-
514 for the level of care offered in the EMS
System or any other applicable health care
licensing board.
(b) Treatment protocols developed locally shall, at a minimum,
meet the requirements of Paragraph (a) of this Rule, shall be
reviewed annually and any change in the treatment protocols
shall be submitted to the OEMS Medical Director for review and
approval at least 30 days prior to the implementation of the
change.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0406 REQUIREMENTS FOR
TREATMENT PROTOCOLS FOR SPECIALTY CARE
TRANSPORT PROGRAMS
(a) Treatment protocols used by medical crew members within a
Specialty Care Transport Program shall:
(1) be approved by the OEMS Medical Director
and incorporate all skills, medications,
equipment, and supplies for Specialty Care
Transport Programs as defined by the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the Office of
Emergency Medical Services,OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(2) not contain medical procedures, medications,
or intravenous fluids that exceed the scope of
practice of the medical crew members.
(b) Treatment protocols shall be reviewed annually, and any
change in the treatment protocols shall be submitted to the
OEMS Medical Director for review and approval at least 30
days prior to the implementation of the change.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0407 REQUIREMENTS FOR
EMERGENCY MEDICAL DISPATCH PRIORITY
REFERENCE SYSTEM
(a) EMDPRS used by EMD'san EMD within an approved EMD
program shall:
(1) be approved by the OEMS Medical Director
and meet or exceed the statewide standard for
EMDPRS as defined by the "North Carolina
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection,"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the Office of Emergency
Medical Services,OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost; and
(2) not exceed the EMD scope of practice defined
by the North Carolina Medical Board pursuant
to G.S. 143-514.
(b) An EMDPRS developed locally shall be reviewed and
updated annually and submitted to the OEMS medical
directorMedical Director for approval. Any change in the
EMDPRS shall be submitted to the OEMS medical
directorMedical Director for review and approval at least 30
days prior to the implementation of the change.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0408 EMS PEER REVIEW
COMMITTEE FOR EMS SYSTEMS
(a) The quality management committeeEMS Peer Review
Committee for an EMS System shall:
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
359
(1) Bebe composed of at least one voting
representative from each of the following
components of the system:
(A) Physicians;physicians
(B) Nurses;nurses;
(C) Medicalmedical facility personnel
such as pharmacists or respiratory
therapists;
(D) EMS educators;
(E) Countycounty government officials;
and
(F) EMS providers.providers; and
(G) EMS personnel.
(2) Appointappoint a physician as chairperson;
(3) Meet,meet, at a minimum, on a quarterly basis;
(4) Ensure that a medical review committee as
referenced in G.S. 143-518(a)(5), or sub-committee
thereof, analyzesanalyze system
data to evaluate the ongoing quality of patient
care and medical direction within the system;
(5) Useuse information gained from system data
analysis to make recommendations regarding
the content of educationalcontinuing education
programs for EMS personnel;
(6) Reviewreview treatment protocols of the EMS
System and make recommendations to the
medical director for changes;
(7) Establishestablish a written procedure to
guarantee reviews for EMS personnel
temporarily suspended by the medical director;
and
(8) Maintain maintain minutes of committee
meetings throughout the approval period of the
EMS System.
(b) The quality management committeeEMS Peer Review
Committee shall adopt written guidelines that address at a
minimum:
(1) Structurestructure of committee membership;
(2) Appointmentappointment of committee
officers;
(3) Appointmentappointment of committee
members;
(4) Lengthlength of terms of committee members;
(5) Frequencyfrequency of attendance of
committee members;
(6) Establishmentestablishment of a quorum for
conducting business; and
(7) Confidentialityconfidentiality of medical
records and personnel issues.
Authority G.S. 143-508(b); 143-509(12).
10A NCAC 13P .0409 EMS PEER REVIEW
COMMITTEE FOR SPECIALTY CARE TRANSPORT
PROGRAMS
(a) The quality management committeeEMS Peer Review
Committee for a Specialty Care Transport Program shall:
(1) Bebe composed of membership as defined in
G.S. 131E-155(16a). The Committee shall
include at least one voting representative from
each of the following components of the
program:
(A) Physicians;physicians;
(B) Nurses;nurses;
(C) Medicalmedical facility personnel
such as pharmacists or respiratory
therapists;
(D) Educators;educators; and
(E) Medicalmedical crew members;
(2) Appointappoint a physician as chairperson;
(3) Meet,meet, at a minimum, on a quarterly basis;
(4) Ensure that a medical review committee as
referenced in G.S. 143-518(a)(5), or sub-committee
thereof, analyzes systemanalyze
program data to evaluate the ongoing quality
of patient care and medical direction within
the program;
(5) Useuse information gained from program data
analysis to make recommendations regarding
the content of educationalcontinuing education
programs for medical crew members;
(6) Reviewreview treatment protocols of the
Specialty Care Transport Programs and make
recommendations to the medical director for
changes;
(7) Establishestablish a written procedure to
guarantee reviews for medical crew members
temporarily suspended by the medical director;
and
(8) Maintain maintain minutes of committee
meetings throughout the approval period of the
Specialty Care Transport Program.
(b) Each quality management committeeEMS Peer Review
Committee shall adopt written guidelines that address at a
minimum:
(1) Structurestructure of committee membership;
(2) Appointmentappointment of committee
officers;
(3) Appointmentappointment of committee
members;
(4) Lengthlength of terms of committee members;
(5) Frequencyfrequency of attendance of
committee members;
(6) Establishmentestablishment of a quorum for
conducting business; and
(7) Confidentialityconfidentiality of medical
records and personnel issues.
Authority G.S. 143-508(b); 143-509(12).
SECTION .0500 – EMS PERSONNEL
10A NCAC 13P .0501 EDUCATIONAL PROGRAMS
(a) An educational program approved to qualify credentialed
EMS personnel to perform within their scope of practice shall be
offered by an EMS educational institution.
(b) Educational programs approved to qualify EMS personnel
for credentialing shall meet the educational objectives of the:
(1) "US DOT NHTSA First Responder: National
Standard Curriculum" for MR personnel;
(2) "US DOT NHTSA EMT-Basic: National
Standard Curriculum" for EMT personnel;
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
360
(3) "US DOT NHTSA EMT-Paramedic: National
Standard Curriculum" for EMT-I and EMT-P
personnel. For EMT-I personnel, the
educational objectives will be limited to the
following:
(A) Module 1: Preparatory
SECTION
TITLE LESSON
OBJECTIVES
1-1 EMS Systems / Roles & Responsibilities 1-1.1 – 1-1.46
1-2 The Well Being of the Paramedic 1-2.1 – 1-2.46
1-4 Medical / Legal Issues 1-4.1 – 1-4.35
1-5 Ethics 1-5.1 – 1-5.11
1-6
General Principles of Pathophysiology
1-6.3; 1-6.5 –1-6.9;
1-6.13 –1-6.16;
1-6.19 – 1-6.25;
1-6.27 – 1-6.31
1-7 Pharmacology 1-7.1 – 1-7.31
1-8
Venous Access / Medication Administration
1-8.1 – 1-8.8;
1-8.10 – 1-8.17;
1-8.19 – 1-8.34;
1-8.36 – 1-8.38;
1-8.40 – 1-8.43
1-9 Therapeutic Communications 1-9.1 – 1-9.21
(B) Module 2: Airway
SECTION TITLE LESSON
OBJECTIVES
2-1
Airway Management & Ventilation
2-1.1 – 2-1.10;
2-1.12 – 2-1.40;
2-1.42 – 2-1.64;
2-1.69;
2-1.73 – 2-1.89;
2-1.93 – 2-1.103;
2-1.104a-d;
2-1.105 – 2-1.106;
2-1.108
(4) "US DOT NHTSA Emergency Medical
Dispatcher: National Standard Curriculum" for
EMD personnel; or
(5) "National Guidelines for Educating EMS
Instructors" for EMS Instructors.
These documents are incoporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and
additions. These documents are available from NHTSA, 400 7th
Street, SW, Washington, D.C. 20590, at no cost.
(c) Educational programs approved to qualify EMS personnel
for renewal of credentials shall follow the guidelines of the:
(1) "US DOT NHTSA First Responder Refresher:
National Standard Curriculum" for MR
personnel;
(2) "US DOT NHTSA EMT-Basic Refresher:
National Standard Curriculum" for EMT
personnel;
(3) "EMT-P and EMT-I Continuing Education
National Guidelines" for EMT-I and EMT-P
personnel; or
(4) "US DOT NHTSA Emergency Medical
Dispatcher: National Standard Curriculum" for
EMD personnel.
These documents are incoporated by reference in accordance
with G.S. 150B-21.6, including subsequent amendments and
additions. These documents are available from NHTSA, 400 7th
Street, SW, Washington, D.C. 20590, at no cost.
Authority G.S. 143-508(d)(3), (d)(4); 143-514.
10A NCAC 13P .0502 INITIAL CREDENTIALING
REQUIREMENTS FOR MR, EMT, EMT-I, EMT-P, AND
EMD
(a) MR, EMT, EMT-I, EMT-P, and EMD applicants shall meet
the following criteria within one year of the completion date of
the approved educational program for their level of application:
(1) Be at least 18 years of age;
(2) Successfully complete a scope of practice
performance evaluation, approved by the
OEMS, for the level of application.
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
361
(A) For MR and EMT credentialing, this
evaluation shall be conducted under
the direction of a Level II EMS
Instructor credentialed at or above the
level of application; and
(B) For EMT-I, EMT-P, and EMD
credentialing, this evaluation shall be
conducted under the direction of the
educational medical advisor, a Level
II EMS Instructor credentialed at or
above the level of application and
designated by the educational medical
advisor; and
(3) Successfully complete a written examination
administered by the OEMS or equivalent.
Applicants who fail the written EMT
examination but achieve a minimum score of
70% on the medical responder subset
contained within the examination may be
credentialed as medical responders. If the
educational program was completed over one
year prior to application, applicants shall
submit evidence of completion of continuing
education during the past year. This
continuing education shall be consistent with
their level of application and approved by the
OEMS.
(b) EMD applicants shall successfully complete, within one
year prior to application, an AHA CPR course or equivalent,
including infant, child, and adult CPR, in addition to
Subparagraph (a)(1), (a)(2), and (a)(3) of this Rule.
Authority G.S. 131E-159 (a)(b); 143-508(d)(3).
10A NCAC 13P .0504 RENEWAL OF CREDENTIALS
FOR MR, EMT, EMT-I, EMT-P, AND EMD
MR, EMT, EMT-I, EMT-P and EMD applicants shall renew
credentials by presenting documentation to the OEMS that they
have successfully completed:
(1) an approved educational program as described
in Rule .0501(c) of this Subchapter; and
(2) within one year prior to renewal, a scope of
practice performance evaluation, approved by
the OEM S, for the level of application:
(a) for MR and EMT renewal, this
evaluation shall be conducted under
the direction of a Level II EMS
Instructor credentialed at or above the
level of application; and
(b) for EMT-I, EMT-P, and EMD
renewal, this evaluation shall be
conducted under the direction of the
educational medical advisor, a Level
II EMS Instructor credentialed at or
above the level of application and
designated by the educational medical
advisor.
Authority G.S. 131-159(a); 143-508(d)(3).
10A NCAC 13P .0506 PRACTICE SETTINGS FOR EMS
PERSONNEL
Credentialed EMS Personnel may function in the following
practice settings in accordance with the protocols approved by
the medical director of the EMS System or Specialty Care
Transport Program with which they are affiliated, and by the
OEMS:
(1) at the location of a physiological or
psychological illness or injury including
transportation to an appropriate treatment
facility if required;
(2) at public or community health facilities in
conjunction with public and community health
initiatives;
(3) in hospitals and clinics;
(4) in residences, facilities, or other locations as
part of wellness or injury prevention initiatives
within the commu nity and the public health
system; and
(5) at mass gatherings or special events.
Authority G.S. 143-508(d)(7).
10A NCAC 13P .0507 CREDENTIALING
REQUIREMENTS FOR LEVEL I EMS INSTRUCTORS
(a) Applicants for credentialing as a Level I EMS Instructor
shall:
(1) be currently credentialed by the OEMS as an
EMT, EMT-P, or EMD;
(2) have three years experience at the scope of
practice for the level of application;
(3) within one year prior to application,
successfully complete both a clinical and
educational scope of practice performance
evaluation, approved by the OEMS, for the
level of application:
(A) for a credential to teach at the EMT
level, this evaluation shall be
conducted under the direction of a
Level II EMS Instructor credentialed
at or above the level of application;
and
(B) for a credential to teach at the EMT-I
or EMT-P levels, this evaluation shall
be conducted under the direction of
the educational medical advisor, a
Level II EMS Instructor credentialed
at or above the level of application
and designated by the educational
medical advisor;
(C) for a credential to teach at the EMD
level, this evaluation shall be
conducted under the direction of the
educational medical advisor or a
Level I EMS Instructor credentialed
at the EMD level designated by the
educational medical advisor;
(4) have 100 hours of formal teaching experience
in an approved EMS educational program or
equivalent;
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
362
(5) successfully complete an educational program
as described in Rule .0501(b)(5) of this
Subchapter;
(6) within one year prior to application, attend a
Level I EMS Instructor workshop sponsored
by the OEMS; and
(7) have a high school diploma or General
Education Development certificate.
(b) The credential of a Level I EMS Instructor shall be valid for
four years, unless any of the following occurs:
(1) the OEMS imposes an administrative action
against the instructor credential; or
(2) the instructor fails to maintain a current EMT,
EMT-I, EMT-P, or EMD credential at the
highest level that the instructor is approved to
teach.
Authority G.S. 143-508(d)(3).
10A NCAC 13P .0508 CREDENTIALING
REQUIREMENTS FOR LEVEL II EMS INSTRUCTORS
(a) Applicants for credentialing as a Level II EMS Instructor
shall:
(1) be currently credentialed by the OEMS as an
EMT, EMT-I, or EMT-P;
(2) complete post-secondary level education equal
to or exceeding an Associate Degree;
(3) within one year prior to application,
successfully complete both a clinical and
educational scope of practice performance
evaluation, approved by the OEMS, for the
level of application:
(A) For a credential to teach at the EMT
level, this evaluation shall be
conducted under the direction of a
Level II EMS Instructor credentialed
at or above the level of application;
and
(B) For a credential to teach at the EMT-I
or EMT-P level, this evaluation shall
be conducted under the direction of
the educational medical advisor, a
Level II EMS Instructor credentialed
at or above the level of application
and designated by the educational
medical advisor;
(C) For a credential to teach at the EMD
level, this evaluation shall be
conducted under the direction of the
educational medical advisor or a
Level I EMS Instructor credentialed
at the EMD level designated by the
educational medical advisor;
(4) have two years teaching experience as a Level
I EMS Instructor or equivalent;
(5) successfully complete the "EMS Education
Administration Course" adopted by the North
Carolina Community College System,
incoporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and additions. This document is
available from the North Carolina Community
College System, 200 West Jones Street,
Raleigh, North Carolina 27603, at no cost; and
(6) attend a Level II EMS Instructor workshop
sponsored by the OEMS;
(b) The credential of a Level II EMS Instructor shall be valid for
four years, unless any of the following occurs:
(1) The OEMS imposes an administrative action
against the instructor credential; or
(2) The instructor fails to maintain a current EMT,
EMT-I, EMT-P, or EMD credential at the
highest level that the instructor is approved to
teach.
Authority G.S. 143-508(d)(3).
10A NCAC 13P .0509 CREDENTIALING OF
INDIVIDUALS TO ADMINISTER LIFESAVING
TREATMENT TO PERSONS SUFFERING AN ADVERSE
REACTION TO AGENTS THAT MIGHT CAUSE
ANAPHYLAXIS
(a) To become credentialed by the North Carolina Medical Care
Commission to administer epinephrine to persons who suffer
adverse reactions to agents that might cause anaphylaxis, a
person shall meet the following:
(1) Be 18 years of age or older; and
(2) Successfullysuccessfully complete an
educational program taught by a physician
licensed to practice medicine in North
Carolina or designee of the physician. The
educational program shall instruct individuals
in the appropriate use of procedures for the
administration of epinephrine to pediatric and
adult victims who suffer adverse reactions to
agents that might cause anaphylaxis and shall
include at a minimum the following:
(A) Definitiondefinition of anaphylaxis;
(B) Agents agents that might cause
anaphylaxis and the distinction
between them, including drugs,
insects, foods, and inhalants;
(C) Recognitionrecognition of symptoms
of anaphylaxis for both pediatric and
adult victims;
(D) Appropriateappropriate emergency
treatment of anaphylaxis as a result of
agents that might cause anaphylaxis;
(E) Availabilityavailability and design of
packages containing equipment for
administering epinephrine to victims
suffering from anaphylaxis as a result
of agents that might cause
anaphylaxis;
(F) Pharmacologypharmacology of
epinephrine including indications,
contraindications, and side effects;
(G) Discussiondiscussion of legal
implications of rendering aid; and
(H) Instructioninstruction that treatment
is to be utilized only in the absence of
the availability of physicians or other
PROPOSED RULES
18:05 NORTH CAROLINA REGISTER September 2, 2003
363
practitioners who are authorized to
administer the treatment.
(b) A credential to administer epinephrine to persons who suffer
adverse reactions to agents that might cause anaphylaxis may be
issued by the North Carolina Medical Care Commission upon
receipt of a completed application signed by the applicant and
the physician who taught or was responsible for the educational
program. Applications may be obtained from the OEMS, 2707
Mail Service Center, Raleigh, North Carolina 27699-2707. All
credentials shall be valid for the period stated on the credential
issued to the applicant.
Authority G.S. 143-508(d)(11); 143-509(9).
10A NCAC 13P .0510 RENEWAL OF CREDENTIALS
FOR LEVEL I AND LEVEL II EMS INSTRUCTORS
(a) Level I and Level II EMS Instructor applicants shall renew
credentials by presenting documentation to the OEMS that they:
(1) are currently credentialed by the OEMS as an
EMT, EMT-I, or EMT-P, or EMD;
(2) successfully completed, within one year prior
to application, both a clinical and educational
scope of practice performance evaluation,
approved by the OEMS, for the level of
application:
(A) To renew a credential to teach at the
EMT level, this evaluation shall be
conducted under the direction of a
Level II EMS Instructor credentialed
at or above the level of application;
(B) To renew a credential to teach at the
EMT-I or EMT-P level, this
evaluation shall be conducted under
the direction of the educational
medical advisor, a Level II EMS
Instructor credentialed at or above the
level of application and designated by
the educational medical advisor; and
(C) To renew a credential to teach at the
EMD level, this evaluation shall be
conducted under the direction of the
educational medical advisor or a
Level I EMS Instructor credentialed
at the EMD level designated by the
educational medical advisor;
(3) completed 96 hours of EMS instruction at the
level of application; and
(4) completed 40 hours of educational
professional development.
(b) The credential of a Level I or Level II EMS Instructor shall
be valid for four years, unless any of the following occurs:
(1) the OEMS imposes an administrative action
against the instructor credential; or
(2) the instructor fails to maintain a current EMT,
EMT-I, EMT-P, or EMD credential at the
highest level that the instructor is approved to
teach.
Authority G.S. 131E-159(a)(b); 143-508(d)(3).
SECTION .0600 – EMS EDUCATIONAL INSTITUTIONS
10A NCAC 13P .0601 CONTINUING EDUCATION
EMS EDUCATIONAL INSTITUTION REQUIREMENTS
(a) Continuing Education EMS Educational Institutions shall be
credentialed by the OEMS to provide EMS continuing education
programs.
(b) Continuing Education EMS Educational Institutions shall
have, at a minimum:
(1) a Level I EMS Instructor as program
coordinator. The program coordinator shall
hold a Level I EMS Instructor credential at a
level equal to or greater than the highest level
of continuing education program offered in the
EMS System or Specialty Care Transport
Program;
(2) a continuing education program consistent
with the EMS System or Specialty Care
Transport Program continuing education plan
for EMS personnel;
(A) In an EMS System, the continuing
education programs for EMD, EMT-I,
and EMT-P shall be reviewed and
approved by the medical director of
the EMS System.
(B) In a Model EMS System, the
continuing education program shall
be reviewed and approved by the
system continuing education
coordinator and medical director.
(C) In a Specialty Care Transport
Program, the continuing education
program shall be reviewed and
approved by Specialty Care Transport
Program Continuing Education
Coordinator and the medical director.
(3) access to instructional supplies and equipment
necessary for students to complete educational
programs as defined in Rule .0501(c) of this
Subchapter;
(4) educational programs offered in accordance
with Rule .0501(c) of this Subchapter;
(5) an Educational Medical Advisor if offering
educational programs that have not been
reviewed and approved by a medical director
of an EMS System or Specialty Care Transport
Program. The Educational Medical Advisor
shall meet the criteria as defined in the "North
Carolina College of Emergency Physicians:
Standards for Medical Oversight and Data
Collection," incorporated by reference in
accordance with G.S. 150B-21.6, including
subsequent amendments and editions. This
document is available from the OEMS, 2707
Mail Service Center, Raleigh, North Carolina
27699-2707, at no cost; and
(6) a written educational plan describing the
delivery of educational programs, the record-keeping
system detailing student attendance
and performance, and the selection and
monitoring of EMS instructors.
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18:05 NORTH CAROLINA REGISTER September 2, 2003
364
(c) An application for credentialing as a Continuing Education
EMS Educational Institution shall be submitted to the OEMS for
review. The application shall demonstrate that the applicant
meets the requirements in Paragraph (b) of this Rule.
(d) Continuing Education EMS Educational Institution
credentials shall be valid for a period of four years.
(e) It is not necessary for Continuing Education EMS
Educational Institutions designated as the primary educational
delivery agency for a Model EMS System to submit an
application for renewal of credentials.
Authority G.S. 143-508(d)(4), (13).
10A NCAC 13P .0602 BASIC EMS EDUCATIONAL
INSTITUTION REQUIREMENTS
(a) Basic EMS Educational Institutions may offer MR, EMT,
and EMD courses for which they have been credentialed by the
OEMS.
(b) For initial courses, Basic EMS Educational Institutions shall
have, at a minimum:
(1) a Level I EMS Instructor as lead course
instructor for MR and EMT courses. The lead
course instructor must be credentialed at a
level equal to or higher than the course
offered;
(2) a Level I EMS Instructor credentialed at the
EMD level as lead course instructor for EMD
courses;
(3) a lead EMS educational program coordinator.
This individual may be either a Level II EMS
Instructor credentialed at or above the highest
level of course offered by the institution, or a
combination of staff who cumulatively meet
the requirements of the Level II EMS
Instructor referenced in this Paragraph. These
individuals may share the responsibilities of
the lead EMS educational coordinator. The
details of this option shall be defined in the
educational plan required in Paragraph (b)(5)
of this Rule. Basic EMS Educational
Institutions offering only EMD courses may
meet this requirement with a Level I EMS
Instructor credentialed at the EMD level;
(4) an Educational Medical Advisor that meets the
criteria as defined in the "North Carolina
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost;
(5) a written educational plan describing the
delivery of educational programs, the record-keeping
system detailing student attendance
and performance; and the selection and
monitoring of EMS instructors; and
(6) access to instructional supplies and equipment
necessary for students to complete educational
programs as defined in Rule .0501(c) of this
Subchapter.
(c) For EMS continuing education programs, Basic EMS
Educational Institutions shall meet the requirements defined in
Paragraphs (a) and (b) of Rule .0601 of this Section.
(d) An application for credentialing as a Basic EMS Educational
Institution shall be submitted to the OEMS for review. The
proposal shall demonstrate that the applicant meets the
requirements in Paragraphs (b) and (c) of this Rule.
(e) Basic EMS Educational Institution credentials shall be valid
for a period of four years.
(f) It is not necessary for Basic EMS Educational Institutions
designated as the primary educational delivery agency for a
Model EMS System to submit an application for renewal of
credentials.
Authority G.S. 143-508(d)(4), (13).
10A NCAC 13P .0603 ADVANCED EMS
EDUCATIONAL INSTITUTION REQUIREMENTS
(a) Advanced EMS Educational Institutions may offer all EMS
educational programs for which they have been credentialed by
the OEMS.
(b) For initial courses, Advanced EMS Educational Institutions
shall have, at a minimum:
(1) a Level I EMS Instructor as lead course
instructor for MR and EMT courses. The lead
course instructor must be credentialed at a
level equal to or higher than the course
offered;
(2) a Level I EMS Instructor credentialed at the
EMD level as lead course instructor for EMD
courses;
(3) a Level II EMS Instructor as lead instructor for
EMT-I and EMT-P courses. The lead course
instructor must be credentialed at a level equal
to or higher than the course offered;
(4) a lead EMS educational program coordinator.
This individual may be either a Level II EMS
Instructor credentialed at or above the highest
level of course offered by the institution, or a
combination of staff who cumulatively meet
the requirements of the Level II EMS
Instructor referenced in this paragraph. These
individuals may share the responsibilities of
the lead EMS educational coordinator. The
details of this option shall be defined in the
educational plan required in Paragraph (b)(6)
of this Rule;
(5) an Educational Medical Advisor that meets the
criteria as defined in the "North Carolina
College of Emergency Physicians: Standards
for Medical Oversight and Data Collection,"
incorporated by reference in accordance with
G.S. 150B-21.6, including subsequent
amendments and editions. This document is
available from the OEMS, 2707 Mail Service
Center, Raleigh, North Carolina 27699-2707,
at no cost;
(6) a written educational plan describing the
delivery of educational programs, the record-
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365
keeping system detailing student attendance
and performance; and the selection and
monitoring of EMS instructors; and
(7) access to instructional supplies and equipment
necessary for students to complete educational
programs as defined in Rule .0501(c) of this
Subchapter.
(c) For EMS continuing education programs, Advanced EMS
Educational Institutions shall meet the requirements defined in
Paragraphs (a) and (b) of Rule .0601 of this Section.
(d) An application for credentialing as an Advanced EMS
Educational Institution shall be submitted to the OEMS for
review. The application shall demonstrate that the applicant
meets the requirements in Paragraphs (b) and (c) of this Rule.
Advanced EMS Educational Institutions holding current
accreditation by a national EMS educational accreditation
agency that has been recognized by OEMS may use this
accreditation as documentation toward meeting the requirements
of Paragraphs (b) and (c) of this Rule.
(e) Advanced Educational Institution credentials shall be valid
for a period of four years.
(f) It is not necessary for Advanced EMS Educational
Institutions designated as the primary educational delivery
agency for a Model EMS System to submit an application for
renewal of credentials.
Authority G.S. 143-508(d)(4), (13).
10A NCAC 13P .0604 TRANSITION FOR APPROVED
TEACHING INSTITUTIONS
Approved Teaching Institutions under contract with the OEMS
as of April 30, 2002, shall be credentialed as an EMS
Educational Institution consistent with the existing level of
approval through December 31, 2003. These institutions may
continue to offer courses currently allowed under the contract
while preparing for credentialing under Ru les .0601, .0602, and
.0603.
Authority G.S. 143-508(b).
SECTION .0700 – ENFORCEMENT
10A NCAC 13P .0701 DENIAL, SUSPENSION,
AMENDMENT OR REVOCATION
(a) The Department may deny, suspend, or revoke the permit of
an ambulance or EMS nontransporting vehicle if the EMS
provider:
(1) fails to substantially comply with the
requirements of Section .0200 of this
Subchapter;
(2) obtains or attempts to obtain a permit through
fraud or misrepresentation; or
(3) fails to provide emergency medical care within
the defined EMS service area in a timely
manner.
(b) In lieu of suspension or revocation, the Department may
issue a temporary permit for an ambulance or EMS
nontransporting vehicle whenever the Department finds that:
(1) the EMS provider to which that vehicle is
assigned has substantially failed to comply
with the provisions of G.S. 131E, Article 7,
and the rules adopted under that article; or
(2) there is a reasonable probability that the EMS
provider can remedy the permit deficiencies
within a length of time determined by the
department; or
(3) there is a reasonable probability that the EMS
provider will be willing and able to remain in
compliance with the rules regarding vehicle
permits for the foreseeable future.
(c) The Department shall give the EMS provider written notice
of the temporary permit. This notice shall be given personally or
by certified mail and shall set forth:
(1) the duration of the temporary permit not to
exceed 60 days;
(2) a copy of the vehicle inspection form;
(3) the statutes or rules alleged to be violated; and
(4) notice to the EMS provider's right to a
contested case hearing on the temporary
permit.
(d) The temporary permit shall be effective immediately upon
its receipt by the EMS provider and shall remain in effect until
the earlier of the expiration date of the permit or until the
Department:
(1) restores the vehicle to full permitted status; or
(2) suspends or revokes the vehicle permit.
(e) The Department may deny, suspend, or revoke the
credentials of EMS personnel for any of the following reasons:
(1) failure to comply with the applicable
performance and credentialing requirements as
found in this Subchapter;
(2) making false statements or representations to
the OEMS or willfully concealing information
in connection with an application for
credentials;
(3) being unable to perform as credentialed EMS
personnel with reasonable skill and safety to
patients and the public by reason of illness, use
of alcohol, drugs, chemicals, or any other type
of material or by reason of any physical or
mental abnormality;
(4) unprofessional conduct, including but not
limited to a failure to comply with the rules
relating to the proper function of credentialed
EMS personnel contained in this Subchapter or
the performance of or attempt to perform a
procedure that is detrimental to the health and
safety of any person or that is beyond the
scope of practice of credentialed EMS
personnel or EMS instructors;
(5) conviction in any court of a crime involving
moral turpitude, a conviction of a felony, or
conviction of a crime involving the scope of
practice of credentialed EMS personnel;
(6) by false representations obtaining or
attempting to obtain money or anything of
value from a patient;
(7) adjudication of mental incompetence;
(8) lack of competence to practice with a
reasonable degree of skill and safety for
patients including but not limited to a failure to
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18:05 NORTH CAROLINA REGISTER September 2, 2003
366
perform a prescribed procedure, failure to
perform a prescribed procedure competently or
performance of a procedure that is not within
the scope of practice of credentialed EMS
personnel or EMS instructors;
(9) making false statements or representations,
willfully concealing information, or failing to
respond within a reasonable period of time and
in a reasonable manner to inquiries from the
OEMS;
(10) testing positive for any substance, legal or
illegal, that is likely to impair the physical or
psychological ability of the credentialed EMS
personnel to perform all required or expected
functions while on duty;
(11) representing or allowing others to represent
that the credentialed EMS personnel has a
credential that the credentialed EMS personnel
does not in fact have; or
(12) failure to comply with G.S. 143-518 regarding
the use or disclosure of records or data
associated with EMS Systems, Specialty Care
Transport Programs, or patients.
(f) The Department may amend any EMS provider license by
reducing it from a full license to a provisional license whenever
the Department finds that:
(1) the licensee has substantially failed to comply
with the provisions of G.S. 131E, Article 7,
and the rules adopted under that article;
(2) there is a reasonable probability that the
licensee can remedy the licensure deficiencies
within a reasonable length of time; and
(3) there is a reasonable probability that the
licensee will be able thereafter to remain in
compliance with the licensure rules for the
foreseeable future.
(g) The Department shall give the licensee written notice of the
amendment to the EMS provider license. This notice shall be
given personally or by certified mail and shall set forth:
(1) the length of the provisional EMS provider
license;
(2) the factual allegations;
(3) the statutes or rules alleged to be violated; and
(4) notice to the EMS provider's right to a
contested case hearing on the amendment of
the EMS provider license.
(h) The provisional EMS provider license shall be effective
immediately upon its receipt by the licensee and shall be posted
in a prominent location at the primary business location of the
EMS provider, accessible to public view, in lieu of the full
license. The provisional license shall remain in effect until the
Department:
(1) restores the licensee to full licensure status; or
(2) revokes the licensee’s license.
(i) The Department may revoke or suspend an EMS provider
license whenever the Department finds that the licensee:
(1) has substantially failed to comply with the
provisions of G.S. 131E, Article 7, and the
rules adopted under that article and it is not
reasonably probable that the licensee can
remedy the licensure deficiencies within a
reasonable length of time;
(2) has substantially failed to comply with the
provisions of G.S. 131E, Article 7, and the
rules adopted under that article and, although
the licensee may be able to remedy the
deficiencies within a reasonable period of
time, it is not reasonably probable that the
licensee will be able to remain in compliance
with licensure rules for the foreseeable future;
(3) has failed to comply with the provision of G.S.
131E, Article 7, and the rules adopted under
that article that endanger the health, safety or
welfare of the patients cared for or transported
by the licensee; or
(4) obtained or attempted to obtain an ambulance
permit, EMS nontransporting vehicle permit,
or EMS provider license through fraud or
misrepresentation.
(j) The issuance of a provisional EMS provider license is not a
procedural prerequisite to the revocation or suspension of a
license pursuant to Paragraph (i) of this Rule.
(k) The Department may amend, deny, suspend, or revoke the
credential of an EMS educational institution for any of the
following reasons:
(1) failure to substantially comply with the
requirements of Section .0600 of this
Subchapter; or
(2) obtaining or attempting to obtain a credential
through fraud or misrepresentation.
(l) The Department may amend, deny, suspend, or revoke the
approval of an EMS System or designation of a Model EMS
System for any of the following reasons:
(1) failure to substantially comply with the
requirements of Section .0200 of this
Subchapter; or
(2) obtaining or attempting to obtain designation
through fraud or misrepresentation.
(m) The Department may amend, deny, suspend, or revoke the
designation of a Specialty Care Transport Program for any of the
following reasons:
(1) failure to substantially comply with the
requirements of Section .0300 of this
Subchapter; or
(2) obtaining or attempting to obtain designation
through fraud or misrepresentation.
Authority G.S. 131E-155.1(d); 131E-157(c); 131E-159(a);
143-508(d)(10).
SECTION .0900 – TRAUMA CENTER STANDARDS AND
APPROVAL
10A NCAC 13P .0901 LEVEL I TRAUMA CENTER
CRITERIA
To receive designation as a Level I Trauma Center, a hospital
shall have the following:
(1) A trauma program and a trauma service that
have been operational for at least six months
prior to application for designation;
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367
(2) Membership in and inclusion of all trauma
patient records in the North Carolina Trauma
Registry for at least six months prior to
submitting a Request for Proposal;
(3) Trauma medical director who is a board-certified
general surgeon. The trauma medical
director must:
(a) Have a minimum of three years
clinical experience on a trauma
service or trauma fellowship training;
(b) Serve on the center's trauma service;
(c) Participate in providing care to
patients with life -threatening or
urgent injuries;
(d) Participate in the North Carolina
Chapter of the ACS Committee on
Trauma as well as other regional and
national trauma organizations;
(e) Remain a current provider in the
ACS' Advanced Trauma Life Support
Course and in the provision of
trauma-related instruction to other
health care personnel; and
(f) Be involved with trauma research and
the publication of results and
presentations.
(4) A full-time trauma nurse coordinator
(TNC)/program manager (TPM) who is a
registered nurse, licensed by the North
Carolina Board of Nursing;
(5) A full-time trauma registrar (TR) who has a
working knowledge of medical terminology, is
able to operate a personal computer, and has
demonstrated the ability to extract data from
the medical record;
(6) A hospital department/division/section for
general surgery, neurological surgery,
emergency medicine, anesthesiology, and
orthopaedic surgery, with designated chair or
physician liaison to the trauma program for
each;
(7) Clinical capabilities in general surgery with
two separate posted call schedules. One shall
be for trauma, one for general surgery. In
those instances where a physician may
simultaneously be listed on both schedules,
there must be a defined back-up surgeon listed
on the schedule to allow the trauma surgeon to
provide care for the trauma patient. The
trauma service director shall specify, in
writing, the specific credentials that each back-up
surgeon must have. These, at a minimum,
must state that the back-up surgeon has
surgical privileges at the trauma center and is
boarded or eligible in general surgery (with
board certification in general surgery within
five years of completing residency). If a
trauma surgeon is simultaneously on call at
more than one hospital, there shall be a
defined, posted trauma surgery back-up call
schedule composed of surgeons credentialed to
serve on the trauma panel.
(8) Response of a trauma team to provide
evaluation and treatment of a trauma patient
24 hours per day that includes:
(a) An in-house Post Graduate Year 4
(PGY4) or senior general surgical
resident, at a minimum, who is a
member of that hospital's surgical
residency program and responds
within 20 minutes of notification;
(b) A trauma attending whose presence at
the patient's bedside within 20
minutes of notification is documented
and who participates in therapeutic
decisions and is present at all
operative procedures;
(c) An emergency physician who is
present in the Emergency Department
24 hours per day who is either board-certified
or prepared in emergency
medicine (by the American Board of
Emergency Medicine or the
American Osteopathic Board of
Emergency Medicine). Emergency
physicians caring only for pediatric
patients may, as an alternative, be
boarded or prepared in pediatric
emergency medicine. Emergency
physicians must be board-certified
within five years after successful
completion of a residency in
emergency medicine and serve as a
designated member of the trauma
team until the arrival of the trauma
surgeon;
(d) Neurosurgery specialists who are
never simultaneously on-call at
another Level II or higher trauma
center, who are promptly available, if
requested by the trauma team leader,
unless there is either an in-house
attending neurosurgeon, a Post
Graduate Year 2 (PGY2) or higher in-house
neurosurgery resident or an in-house
trauma surgeon or emergency
physician as long as the institution
can document management
guidelines and annual continuing
medical education for neurosurgical
emergencies. There must be a
specified written back-up on the call
schedule whenever the neurosurgeon
is simultaneously on-call at a hospital
other than the trauma center;
(e) Orthopaedic surgery specialists who
are never simultaneously on-call at
another Level II or higher trauma
center, who are promptly available, if
requested by the trauma team leader,
unless there is either an in-house
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368
attending orthopaedic surgeon, a Post
Graduate Year 2 (PGY2) or higher in-house
orthopaedic surgery resident or
an in-house trauma surgeon or
emergency physician as long as the
institution can document management
guidelines and annual continuing
medical education for orthopaedic
emergencies. There must be a
specified written back-up on the call
schedule whenever the orthopaedist is
simultaneously on-call at a hospital
other than the trauma center;
(f) An in-house anesthesiologist or a
Clinical Anesthesiology Year 3
(CA3) resident as long as an
anesthesiologist on-call is advised
and promptly available if requested
by the trauma team leader, and
(g) Registered nursing personnel trained
in the care of trauma patients.
(9) A written credentialing process established by
the Department of Surgery to approve mid-level
practitione